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        "resumen" => "<span class="elsevierStyleSectionTitle">Aims</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">This study classifies cases of traumatic diaphragmatic hernias &#40;TDH&#41; in patients admitted to the Intensive Care Unit &#40;ICU&#41; of the Coimbra University Hospitals &#40;HUC&#41; from 1990 to 2004&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Retrospective analysis of 34 cases of TDH&#44; studying anatomical location&#44; place and time of diagnosis&#44; complementary tests aiding diagnosis&#44; herniated organs&#44; associated traumatism&#44; morbidity and mortality&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Twenty-eight male and six female patients with an average age of 40&#46;5 years<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#46;5&#44; average SAPS score 38&#46;8&#46; Average lenght of stay was 19&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;6 days&#44; all suffered from closed traumatism and were put on artificial ventilation&#46; The left-side diaphragm was more frequently affected &#40;94&#46;1&#37;&#41; then the right&#46; Diagnosis in 19 cases was made up in the first six hours following the diagnosis of traumatism&#44; in four cases within 12 hours and in the remaining cases between 48 hours and 16 years after traumatism&#46; In 13 patients the diagnosis was established intra-operatively&#46; The stomach was typically one of the herniated organs&#46; The most frequently associated lesions at the thoracic level were pulmonary contusion&#44; haemothorax and pneumothorax&#44; and at the abdominal level&#44; haemoperitoneum and splenic lesion&#46; The rates for complications and mortality were 55&#46;8&#37; and 11&#46;7&#37; respectively&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">TDH mainly occurs on the left side through closed thoraco-abdominal trauma following road traffic accidents&#46; This group of patients&#44; on average younger than others admitted to ICU&#44; presents a longer average hospitalisation period&#44; but has lower rates of mortality and lower SAPS severity scores&#46; The most commonly herniated organ was the stomach and the most frequently encountered lesions were cranial-encephalic&#44; splenic and pleural traumatisms&#46; Pre-operative diagnosis of diaphragmatic injuries is difficult and a high index of clinical suspicion is needed after thoracoabdominal trauma&#46; This diagnosis should always be considered a possibility in cases of closed thoraco-abdominal traumas&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objectivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Os autores propuseram-se realizar uma revis&#227;o e caracteriza&#231;&#227;o dos casos de h&#233;rnias diafragm&#225;ticas &#40;HD&#41; traum&#225;ticas internados no Servi&#231;o de Medicina Intensiva dos Hospitais da Universidade de Coimbra &#40;SMI-HUC&#41; de 1990 a 2004&#46;</p> <span class="elsevierStyleSectionTitle">Material e m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An&#225;lise retrospectiva de 34 casos de HD traum&#225;tica&#44; tendo em aten&#231;&#227;o a localiza&#231;&#227;o anat&#243;mica&#44; o local e o momento do diagn&#243;stico&#44; os exames complementares que permitiram o diagn&#243;stico&#44; os &#243;rg&#227;os herniados&#44; os traumatismos associados&#44; a morbilidade e a mortalidade&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Vinte e oito doentes eram do sexo masculino e 6 do feminino&#44; com m&#233;dia de idades de 40&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#44;5 anos&#59; o valor m&#233;dio do SAPS foi de 38&#44;8&#46; A dura&#231;&#227;o m&#233;dia de internamento foi de 19&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;6 dias&#44; todos sofreram traumatismo fechado e foram submetidos a ventila&#231;&#227;o artificial&#46; A h&#233;rnia localizava-se &#224; esquerda em 94&#44;1&#37; dos casos&#46; O diagn&#243;stico em 19 dos casos foi efectuado at&#233; 6 horas ap&#243;s o traumatismo&#44; em 4 casos at&#233; &#224;s 12 horas&#44; e os restantes entre 48 horas e 16 anos ap&#243;s o traumatismo&#46; Em 13 doentes o diagn&#243;stico foi intra- operat&#243;rio&#46; Dos &#243;rg&#227;os herniados&#44; o est&#244;mago estava presente na maioria da situa&#231;&#245;es&#46; As les&#245;es associadas mais frequentes foram&#44; a n&#237;vel tor&#225;cico&#44; a contus&#227;o pulmonar&#44; o hemot&#243;rax e o pneumot&#243;rax&#44; e a n&#237;vel abdominal o hemoperitoneu e a les&#227;o espl&#233;nica&#46; A taxa de complica&#231;&#245;es e de mortalidade foi 55&#44;8&#37; e de 11&#44;7&#37;&#44; respectivamente&#46;</p> <span class="elsevierStyleSectionTitle">Conclus&#245;es</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A HD ocorreu maioritariamente &#224; esquerda por traumatismo toraco-abdominal fechado na sequ&#234;ncia de acidente de via&#231;&#227;o&#46; Este grupo de doentes&#44; em rela&#231;&#227;o aos valores m&#233;dios do Servi&#231;o&#44; era mais jovem&#44; apresentava maior dura&#231;&#227;o m&#233;dia de internamento&#44; apresentando&#44; no entanto&#44; menores taxa de mortalidade e &#237;ndice de gravidade &#40;SAPS&#41;&#46; O &#243;rg&#227;o herniado mais frequente foi o est&#244;mago&#44; e as les&#245;es associadas mais encontradas foram os traumatismos cr&#226;nio-encef&#225;lico&#44; espl&#233;nico e pleuro-costal&#46; A dificuldade de diagn&#243;stico pr&#233;-operat&#243;ria continua a requerer elevado grau de suspei&#231;&#227;o&#44; exigindo-se sempre a coloca&#231;&#227;o desta hip&#243;tese de diagn&#243;stico no contexto de traumatismos toraco-abdominais fechados&#46;</p>"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
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                        "titulo" => "Invited Comment in Thoracic Surgery&#58; Surgical Management of Chest Injuries"
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                        0 => array:2 [
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                          "autores" => array:2 [
                            0 => "F&#46; Robert"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Juan A&#46; Ascensio"
                            1 => "P&#46; Patrizio"
                            2 => "D&#46; Demetrios"
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                  ]
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46; Rodriguez-Morales"
                            1 => "A&#46; Rodriguez"
                            2 => "Shatney"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "1986"
                        "volumen" => "26"
                        "numero" => "5"
                        "paginaInicial" => "438"
                        "paginaFinal" => "444"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3701892"
                            "web" => "Medline"
                          ]
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                          "autores" => array:4 [
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                            2 => "A&#46;B&#46; Shah"
                            3 => "B&#46;J&#46; Rowlands"
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                      "Revista" => array:7 [
                        "tituloSerie" => "Ann R Coll Surg Engl"
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                        "numero" => "2"
                        "paginaInicial" => "97"
                        "paginaFinal" => "100"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3784594"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Blunt and penetrating diaphragmatic injuries with or without herniation of organs into the chest"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46;N&#46; Symbas"
                            1 => "S&#46;E&#46; Vlasis"
                            2 => "C&#46; Hatcher Jr&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "1986"
                        "volumen" => "42"
                        "numero" => "2"
                        "paginaInicial" => "158"
                        "paginaFinal" => "162"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3741013"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Blunt rupture of the diaphragm&#58; mechanism&#44; diagnosis&#44; and treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46;A&#46; Kearney"
                            1 => "S&#46;W&#46; Rouhana"
                            2 => "R&#46;E&#46; Burney"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Emerg Med"
                        "fecha" => "1989"
                        "volumen" => "18"
                        "numero" => "12"
                        "paginaInicial" => "1326"
                        "paginaFinal" => "1330"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2589701"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Delayed presentation of traumatic diaphragmatic hernia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;M&#46; Hegarty"
                            1 => "J&#46;V&#46; Bryer"
                            2 => "I&#46;B&#46; Angorn"
                            3 => "L&#46;W&#46; Baker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "1978"
                        "volumen" => "188"
                        "numero" => "2"
                        "paginaInicial" => "229"
                        "paginaFinal" => "233"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/686890"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Delayed presentation of traumatic diaphragmatic hernia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "W&#46;L&#46; Saber"
                            1 => "E&#46;E&#46; Moore"
                            2 => "A&#46;R&#46; Hopeman"
                            3 => "W&#46;E&#46; Aragon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "J Emerg Med"
                        "fecha" => "1986"
                        "volumen" => "4"
                        "numero" => "1"
                        "paginaInicial" => "1"
                        "paginaFinal" => "7"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3734385"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Delayed presentation of traumatic diaphragmatic hernia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "K&#46; McHugh"
                            1 => "B&#46;C&#46; Ogilvie"
                            2 => "F&#46;J&#46; Brunton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Clin Radiol"
                        "fecha" => "1991"
                        "volumen" => "43"
                        "numero" => "4"
                        "paginaInicial" => "246"
                        "paginaFinal" => "250"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2025995"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Post-traumatic diaphragmatic hernia with late diagnosis&#46; Report of a clinical case"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "M&#46;G&#46; Cristofaro"
                            1 => "F&#46; Lazzaro"
                            2 => "D&#46; Cafaro"
                            3 => "R&#46; Natale"
                            4 => "P&#46; Mauro"
                            5 => "N&#46; Savino"
                            6 => "S&#46; Musella"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Ital Chir"
                        "fecha" => "2000"
                        "volumen" => "71"
                        "numero" => "5"
                        "paginaInicial" => "595"
                        "paginaFinal" => "598"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11217477"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Missed diaphragm rupture following blunt trauma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;M&#46; Cupitt"
                            1 => "M&#46;B&#46; Smith"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Anaesth Intensive Care"
                        "fecha" => "2001"
                        "volumen" => "29"
                        "numero" => "3"
                        "paginaInicial" => "292"
                        "paginaFinal" => "296"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11439804"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic delay in post-traumatic diaphragmatic ruptures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "E&#46; Mercadante"
                            1 => "T&#46; De Giacomo"
                            2 => "E&#46;A&#46; Rendina"
                            3 => "F&#46; Venuta"
                            4 => "M&#46; Moretti"
                            5 => "M&#46;T&#46; Aratari"
                            6 => "G&#46; Furio Coloni"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Minerva Chir"
                        "fecha" => "2001"
                        "volumen" => "56"
                        "numero" => "3"
                        "paginaInicial" => "299"
                        "paginaFinal" => "302"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11423797"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Delayed presentation of traumatic rupture of the diaphragm"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;I&#46; Seleem"
                            1 => "A&#46;M&#46; Al-Hashemy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Saudi Med J"
                        "fecha" => "2001"
                        "volumen" => "22"
                        "numero" => "8"
                        "paginaInicial" => "714"
                        "paginaFinal" => "717"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11573120"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Delayed presentation of traumatic rupture of the diaphragm"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46;L&#46; Shreck"
                            1 => "T&#46;W&#46; Toalson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "J Okla State Med Assoc"
                        "fecha" => "2003"
                        "volumen" => "96"
                        "numero" => "4"
                        "paginaInicial" => "181"
                        "paginaFinal" => "183"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12733206"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Traumatic diaphragmatic hernia with delayed presentation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Y&#46;K&#46; Lin"
                            1 => "B&#46;S&#46; Huang"
                            2 => "C&#46;S&#46; Shih"
                            3 => "W&#46;H&#46; Hsu"
                            4 => "M&#46;H&#46; Huaug"
                            5 => "C&#46;H&#46; Lee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Zhonghua Yi Xue Za Zhi &#40;Taipei&#41;"
                        "fecha" => "1999"
                        "volumen" => "62"
                        "numero" => "4"
                        "paginaInicial" => "223"
                        "paginaFinal" => "229"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gastric incarceration and perforation following posttraumatic diaphragmatic hernia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "I&#46; Prieto"
                            1 => "J&#46;P&#46; Robledo"
                            2 => "V&#46; Trelles"
                            3 => "R&#46; Ibanez"
                            4 => "A&#46; Prieto"
                            5 => "A&#46; Celada"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Acta Chir Belg"
                        "fecha" => "2001"
                        "volumen" => "101"
                        "numero" => "2"
                        "paginaInicial" => "81"
                        "paginaFinal" => "83"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11396058"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rupture of the diaphragm after blunt trauma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:10 [
                            0 => "W&#46;C&#46; Lee"
                            1 => "R&#46;J&#46; Chen"
                            2 => "J&#46;F&#46; Fang"
                            3 => "C&#46;C&#46; Wang"
                            4 => "H&#46;Y&#46; Chen"
                            5 => "S&#46;C&#46; Chen"
                            6 => "T&#46;L&#46; Hwang"
                            7 => "L&#46;B&#46; Jeng"
                            8 => "Y&#46;Y&#46; Jan"
                            9 => "C&#46;S&#46; Wang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Eur J Surg"
                        "fecha" => "1994"
                        "volumen" => "160"
                        "numero" => "9"
                        "paginaInicial" => "479"
                        "paginaFinal" => "483"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7849166"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diaphragm rupture caused by closed trauma&#46; A more and more frequent condition"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:8 [
                            0 => "A&#46; Versaci"
                            1 => "R&#46; Caminiti"
                            2 => "T&#46; Centorrino"
                            3 => "M&#46; Rossitto"
                            4 => "S&#46; Pante"
                            5 => "C&#46; Mastrojeni"
                            6 => "F&#46; Monaco"
                            7 => "A&#46; Ciccolo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "G Chir"
                        "fecha" => "2000"
                        "volumen" => "21"
                        "numero" => "8-9"
                        "paginaInicial" => "343"
                        "paginaFinal" => "347"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11008410"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Imaging of diaphragmatic injuries"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "K&#46; Shanmuganathan"
                            1 => "K&#46; Killeen"
                            2 => "S&#46;E&#46; Mirvis"
                            3 => "C&#46;S&#46; White"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "J Thorac Imaging"
                        "fecha" => "2000"
                        "volumen" => "15"
                        "numero" => "2"
                        "paginaInicial" => "104"
                        "paginaFinal" => "111"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10798629"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic sensitivity of computerized tomography in closed trauma of the diaphragm&#46; Retrospective study of 35 consecutive cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:8 [
                            0 => "M&#46; Scaglione"
                            1 => "F&#46; Pinto"
                            2 => "R&#46; Grassi"
                            3 => "S&#46; Romano"
                            4 => "S&#46; Giovine"
                            5 => "M&#46; Sacco"
                            6 => "A&#46;L&#46; Forner"
                            7 => "L&#46; Romano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Radiol Med &#40;Torino&#41;"
                        "fecha" => "2000"
                        "volumen" => "99"
                        "paginaInicial" => "46"
                        "paginaFinal" => "50"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The diagnostic dilemma of traumatic rupture of the diaphragm"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "T&#46; Nau"
                            1 => "H&#46; Seitz"
                            2 => "M&#46; Mousavi"
                            3 => "V&#46; Vecsei"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s004640090096"
                      "Revista" => array:7 [
                        "tituloSerie" => "Surg Endosc"
                        "fecha" => "2001"
                        "volumen" => "15"
                        "numero" => "9"
                        "paginaInicial" => "992"
                        "paginaFinal" => "996"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11443468"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Imaging of diaphragmatic injury&#58; a diagnostic challenge&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46; Iochum"
                            1 => "T&#46; Ludig"
                            2 => "F&#46; Walter"
                            3 => "H&#46; Sebbag"
                            4 => "G&#46; Grosdidier"
                            5 => "A&#46;G&#46; Blum"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1148/radiographics.22.suppl_1.g02oc14s103"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiographics"
                        "fecha" => "2002"
                        "volumen" => "22"
                        "paginaInicial" => "S103"
                        "paginaFinal" => "S116"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12376604"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Traumatic diaphragmatic hernia"
                      "autores" => array:1 [
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                            4 => "P&#46; Varvatsoulis"
                            5 => "B&#46; Gougoutas"
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Traumatic diaphragmatic hernias: Retrospective analysis
Hérnias diafragmáticas traumáticas: Revisão casuística
J.P.A. Sousa1, J.P. Baptista2, L. Martins3, J. Pimentel4,5
1 Assistente Hospitalar Graduado/Graduate Hospital Assistant, Hospitais da Universidade de Coimbra
2 Assistente Hospitalar/Hospital Assistant, Hospitais da Universidade de Coimbra
3 Interno Complementar de Cirurgia Geral/General Surgery Intern, Hospitais da Universidade de Coimbra
4 Director de Serviço/Head of Department, Hospitais da Universidade de Coimbra
5 Serviço de Medicina Intensiva – Hospitais da Universidade de Coimbra
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        "resumen" => "<span class="elsevierStyleSectionTitle">Aims</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">This study classifies cases of traumatic diaphragmatic hernias &#40;TDH&#41; in patients admitted to the Intensive Care Unit &#40;ICU&#41; of the Coimbra University Hospitals &#40;HUC&#41; from 1990 to 2004&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Retrospective analysis of 34 cases of TDH&#44; studying anatomical location&#44; place and time of diagnosis&#44; complementary tests aiding diagnosis&#44; herniated organs&#44; associated traumatism&#44; morbidity and mortality&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Twenty-eight male and six female patients with an average age of 40&#46;5 years<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#46;5&#44; average SAPS score 38&#46;8&#46; Average lenght of stay was 19&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;6 days&#44; all suffered from closed traumatism and were put on artificial ventilation&#46; The left-side diaphragm was more frequently affected &#40;94&#46;1&#37;&#41; then the right&#46; Diagnosis in 19 cases was made up in the first six hours following the diagnosis of traumatism&#44; in four cases within 12 hours and in the remaining cases between 48 hours and 16 years after traumatism&#46; In 13 patients the diagnosis was established intra-operatively&#46; The stomach was typically one of the herniated organs&#46; The most frequently associated lesions at the thoracic level were pulmonary contusion&#44; haemothorax and pneumothorax&#44; and at the abdominal level&#44; haemoperitoneum and splenic lesion&#46; The rates for complications and mortality were 55&#46;8&#37; and 11&#46;7&#37; respectively&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">TDH mainly occurs on the left side through closed thoraco-abdominal trauma following road traffic accidents&#46; This group of patients&#44; on average younger than others admitted to ICU&#44; presents a longer average hospitalisation period&#44; but has lower rates of mortality and lower SAPS severity scores&#46; The most commonly herniated organ was the stomach and the most frequently encountered lesions were cranial-encephalic&#44; splenic and pleural traumatisms&#46; Pre-operative diagnosis of diaphragmatic injuries is difficult and a high index of clinical suspicion is needed after thoracoabdominal trauma&#46; This diagnosis should always be considered a possibility in cases of closed thoraco-abdominal traumas&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objectivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Os autores propuseram-se realizar uma revis&#227;o e caracteriza&#231;&#227;o dos casos de h&#233;rnias diafragm&#225;ticas &#40;HD&#41; traum&#225;ticas internados no Servi&#231;o de Medicina Intensiva dos Hospitais da Universidade de Coimbra &#40;SMI-HUC&#41; de 1990 a 2004&#46;</p> <span class="elsevierStyleSectionTitle">Material e m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An&#225;lise retrospectiva de 34 casos de HD traum&#225;tica&#44; tendo em aten&#231;&#227;o a localiza&#231;&#227;o anat&#243;mica&#44; o local e o momento do diagn&#243;stico&#44; os exames complementares que permitiram o diagn&#243;stico&#44; os &#243;rg&#227;os herniados&#44; os traumatismos associados&#44; a morbilidade e a mortalidade&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Vinte e oito doentes eram do sexo masculino e 6 do feminino&#44; com m&#233;dia de idades de 40&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#44;5 anos&#59; o valor m&#233;dio do SAPS foi de 38&#44;8&#46; A dura&#231;&#227;o m&#233;dia de internamento foi de 19&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;6 dias&#44; todos sofreram traumatismo fechado e foram submetidos a ventila&#231;&#227;o artificial&#46; A h&#233;rnia localizava-se &#224; esquerda em 94&#44;1&#37; dos casos&#46; O diagn&#243;stico em 19 dos casos foi efectuado at&#233; 6 horas ap&#243;s o traumatismo&#44; em 4 casos at&#233; &#224;s 12 horas&#44; e os restantes entre 48 horas e 16 anos ap&#243;s o traumatismo&#46; Em 13 doentes o diagn&#243;stico foi intra- operat&#243;rio&#46; Dos &#243;rg&#227;os herniados&#44; o est&#244;mago estava presente na maioria da situa&#231;&#245;es&#46; As les&#245;es associadas mais frequentes foram&#44; a n&#237;vel tor&#225;cico&#44; a contus&#227;o pulmonar&#44; o hemot&#243;rax e o pneumot&#243;rax&#44; e a n&#237;vel abdominal o hemoperitoneu e a les&#227;o espl&#233;nica&#46; A taxa de complica&#231;&#245;es e de mortalidade foi 55&#44;8&#37; e de 11&#44;7&#37;&#44; respectivamente&#46;</p> <span class="elsevierStyleSectionTitle">Conclus&#245;es</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A HD ocorreu maioritariamente &#224; esquerda por traumatismo toraco-abdominal fechado na sequ&#234;ncia de acidente de via&#231;&#227;o&#46; Este grupo de doentes&#44; em rela&#231;&#227;o aos valores m&#233;dios do Servi&#231;o&#44; era mais jovem&#44; apresentava maior dura&#231;&#227;o m&#233;dia de internamento&#44; apresentando&#44; no entanto&#44; menores taxa de mortalidade e &#237;ndice de gravidade &#40;SAPS&#41;&#46; O &#243;rg&#227;o herniado mais frequente foi o est&#244;mago&#44; e as les&#245;es associadas mais encontradas foram os traumatismos cr&#226;nio-encef&#225;lico&#44; espl&#233;nico e pleuro-costal&#46; A dificuldade de diagn&#243;stico pr&#233;-operat&#243;ria continua a requerer elevado grau de suspei&#231;&#227;o&#44; exigindo-se sempre a coloca&#231;&#227;o desta hip&#243;tese de diagn&#243;stico no contexto de traumatismos toraco-abdominais fechados&#46;</p>"
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                          "autores" => array:2 [
                            0 => "A&#46; Beeson"
                            1 => "Z&#46; Popovici"
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                        "paginaInicial" => "317"
                        "paginaFinal" => "322"
                        "serieFecha" => "1991"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diaphragmatic Injuries in Handbook of Trauma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "F&#46; Robert"
                            1 => "Wilson"
                          ]
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                      ]
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                    0 => array:1 [
                      "Libro" => array:3 [
                        "edicion" => "2nd edition"
                        "fecha" => "1999"
                        "editorial" => "McGraw-Hill"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib3"
              "etiqueta" => "3&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Injury to the Diaphragm&#44; in Trauma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Juan A&#46; Ascensio"
                            1 => "P&#46; Patrizio"
                            2 => "D&#46; Demetrios"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "edicion" => "fifth edition"
                        "fecha" => "2004"
                        "editorial" => "McGraw-Hill"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute rupture of the diaphragm in blunt trauma&#58; analysis of 60 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46; Rodriguez-Morales"
                            1 => "A&#46; Rodriguez"
                            2 => "Shatney"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "1986"
                        "volumen" => "26"
                        "numero" => "5"
                        "paginaInicial" => "438"
                        "paginaFinal" => "444"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3701892"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Traumatic diaphragmatic rupture&#58; associated injuries and outcome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46; Simpson"
                            1 => "D&#46;N&#46; Lobo"
                            2 => "A&#46;B&#46; Shah"
                            3 => "B&#46;J&#46; Rowlands"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann R Coll Surg Engl"
                        "fecha" => "2000"
                        "volumen" => "82"
                        "numero" => "2"
                        "paginaInicial" => "97"
                        "paginaFinal" => "100"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10743425"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute injuries of the diaphragm&#46; An analysis of 165 cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46;G&#46; Wiencek Jr&#46;"
                            1 => "R&#46;F&#46; Wilson"
                            2 => "Z&#46; Steiger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "1986"
                        "volumen" => "92"
                        "numero" => "6"
                        "paginaInicial" => "989"
                        "paginaFinal" => "993"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3784594"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Blunt and penetrating diaphragmatic injuries with or without herniation of organs into the chest"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46;N&#46; Symbas"
                            1 => "S&#46;E&#46; Vlasis"
                            2 => "C&#46; Hatcher Jr&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "1986"
                        "volumen" => "42"
                        "numero" => "2"
                        "paginaInicial" => "158"
                        "paginaFinal" => "162"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3741013"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Blunt rupture of the diaphragm&#58; mechanism&#44; diagnosis&#44; and treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46;A&#46; Kearney"
                            1 => "S&#46;W&#46; Rouhana"
                            2 => "R&#46;E&#46; Burney"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Emerg Med"
                        "fecha" => "1989"
                        "volumen" => "18"
                        "numero" => "12"
                        "paginaInicial" => "1326"
                        "paginaFinal" => "1330"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2589701"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Delayed presentation of traumatic diaphragmatic hernia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;M&#46; Hegarty"
                            1 => "J&#46;V&#46; Bryer"
                            2 => "I&#46;B&#46; Angorn"
                            3 => "L&#46;W&#46; Baker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "1978"
                        "volumen" => "188"
                        "numero" => "2"
                        "paginaInicial" => "229"
                        "paginaFinal" => "233"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/686890"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Delayed presentation of traumatic diaphragmatic hernia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "W&#46;L&#46; Saber"
                            1 => "E&#46;E&#46; Moore"
                            2 => "A&#46;R&#46; Hopeman"
                            3 => "W&#46;E&#46; Aragon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "J Emerg Med"
                        "fecha" => "1986"
                        "volumen" => "4"
                        "numero" => "1"
                        "paginaInicial" => "1"
                        "paginaFinal" => "7"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3734385"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Delayed presentation of traumatic diaphragmatic hernia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "K&#46; McHugh"
                            1 => "B&#46;C&#46; Ogilvie"
                            2 => "F&#46;J&#46; Brunton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Clin Radiol"
                        "fecha" => "1991"
                        "volumen" => "43"
                        "numero" => "4"
                        "paginaInicial" => "246"
                        "paginaFinal" => "250"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2025995"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Post-traumatic diaphragmatic hernia with late diagnosis&#46; Report of a clinical case"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "M&#46;G&#46; Cristofaro"
                            1 => "F&#46; Lazzaro"
                            2 => "D&#46; Cafaro"
                            3 => "R&#46; Natale"
                            4 => "P&#46; Mauro"
                            5 => "N&#46; Savino"
                            6 => "S&#46; Musella"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Ital Chir"
                        "fecha" => "2000"
                        "volumen" => "71"
                        "numero" => "5"
                        "paginaInicial" => "595"
                        "paginaFinal" => "598"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11217477"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Missed diaphragm rupture following blunt trauma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;M&#46; Cupitt"
                            1 => "M&#46;B&#46; Smith"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Anaesth Intensive Care"
                        "fecha" => "2001"
                        "volumen" => "29"
                        "numero" => "3"
                        "paginaInicial" => "292"
                        "paginaFinal" => "296"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11439804"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic delay in post-traumatic diaphragmatic ruptures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "E&#46; Mercadante"
                            1 => "T&#46; De Giacomo"
                            2 => "E&#46;A&#46; Rendina"
                            3 => "F&#46; Venuta"
                            4 => "M&#46; Moretti"
                            5 => "M&#46;T&#46; Aratari"
                            6 => "G&#46; Furio Coloni"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Minerva Chir"
                        "fecha" => "2001"
                        "volumen" => "56"
                        "numero" => "3"
                        "paginaInicial" => "299"
                        "paginaFinal" => "302"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11423797"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Delayed presentation of traumatic rupture of the diaphragm"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;I&#46; Seleem"
                            1 => "A&#46;M&#46; Al-Hashemy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Saudi Med J"
                        "fecha" => "2001"
                        "volumen" => "22"
                        "numero" => "8"
                        "paginaInicial" => "714"
                        "paginaFinal" => "717"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11573120"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Delayed presentation of traumatic rupture of the diaphragm"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46;L&#46; Shreck"
                            1 => "T&#46;W&#46; Toalson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "J Okla State Med Assoc"
                        "fecha" => "2003"
                        "volumen" => "96"
                        "numero" => "4"
                        "paginaInicial" => "181"
                        "paginaFinal" => "183"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12733206"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Traumatic diaphragmatic hernia with delayed presentation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Y&#46;K&#46; Lin"
                            1 => "B&#46;S&#46; Huang"
                            2 => "C&#46;S&#46; Shih"
                            3 => "W&#46;H&#46; Hsu"
                            4 => "M&#46;H&#46; Huaug"
                            5 => "C&#46;H&#46; Lee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Zhonghua Yi Xue Za Zhi &#40;Taipei&#41;"
                        "fecha" => "1999"
                        "volumen" => "62"
                        "numero" => "4"
                        "paginaInicial" => "223"
                        "paginaFinal" => "229"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gastric incarceration and perforation following posttraumatic diaphragmatic hernia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "I&#46; Prieto"
                            1 => "J&#46;P&#46; Robledo"
                            2 => "V&#46; Trelles"
                            3 => "R&#46; Ibanez"
                            4 => "A&#46; Prieto"
                            5 => "A&#46; Celada"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Acta Chir Belg"
                        "fecha" => "2001"
                        "volumen" => "101"
                        "numero" => "2"
                        "paginaInicial" => "81"
                        "paginaFinal" => "83"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11396058"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rupture of the diaphragm after blunt trauma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:10 [
                            0 => "W&#46;C&#46; Lee"
                            1 => "R&#46;J&#46; Chen"
                            2 => "J&#46;F&#46; Fang"
                            3 => "C&#46;C&#46; Wang"
                            4 => "H&#46;Y&#46; Chen"
                            5 => "S&#46;C&#46; Chen"
                            6 => "T&#46;L&#46; Hwang"
                            7 => "L&#46;B&#46; Jeng"
                            8 => "Y&#46;Y&#46; Jan"
                            9 => "C&#46;S&#46; Wang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Eur J Surg"
                        "fecha" => "1994"
                        "volumen" => "160"
                        "numero" => "9"
                        "paginaInicial" => "479"
                        "paginaFinal" => "483"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7849166"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diaphragm rupture caused by closed trauma&#46; A more and more frequent condition"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:8 [
                            0 => "A&#46; Versaci"
                            1 => "R&#46; Caminiti"
                            2 => "T&#46; Centorrino"
                            3 => "M&#46; Rossitto"
                            4 => "S&#46; Pante"
                            5 => "C&#46; Mastrojeni"
                            6 => "F&#46; Monaco"
                            7 => "A&#46; Ciccolo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "G Chir"
                        "fecha" => "2000"
                        "volumen" => "21"
                        "numero" => "8-9"
                        "paginaInicial" => "343"
                        "paginaFinal" => "347"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11008410"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Imaging of diaphragmatic injuries"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "K&#46; Shanmuganathan"
                            1 => "K&#46; Killeen"
                            2 => "S&#46;E&#46; Mirvis"
                            3 => "C&#46;S&#46; White"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "J Thorac Imaging"
                        "fecha" => "2000"
                        "volumen" => "15"
                        "numero" => "2"
                        "paginaInicial" => "104"
                        "paginaFinal" => "111"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10798629"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic sensitivity of computerized tomography in closed trauma of the diaphragm&#46; Retrospective study of 35 consecutive cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:8 [
                            0 => "M&#46; Scaglione"
                            1 => "F&#46; Pinto"
                            2 => "R&#46; Grassi"
                            3 => "S&#46; Romano"
                            4 => "S&#46; Giovine"
                            5 => "M&#46; Sacco"
                            6 => "A&#46;L&#46; Forner"
                            7 => "L&#46; Romano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Radiol Med &#40;Torino&#41;"
                        "fecha" => "2000"
                        "volumen" => "99"
                        "paginaInicial" => "46"
                        "paginaFinal" => "50"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The diagnostic dilemma of traumatic rupture of the diaphragm"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "T&#46; Nau"
                            1 => "H&#46; Seitz"
                            2 => "M&#46; Mousavi"
                            3 => "V&#46; Vecsei"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s004640090096"
                      "Revista" => array:7 [
                        "tituloSerie" => "Surg Endosc"
                        "fecha" => "2001"
                        "volumen" => "15"
                        "numero" => "9"
                        "paginaInicial" => "992"
                        "paginaFinal" => "996"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11443468"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Imaging of diaphragmatic injury&#58; a diagnostic challenge&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46; Iochum"
                            1 => "T&#46; Ludig"
                            2 => "F&#46; Walter"
                            3 => "H&#46; Sebbag"
                            4 => "G&#46; Grosdidier"
                            5 => "A&#46;G&#46; Blum"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1148/radiographics.22.suppl_1.g02oc14s103"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiographics"
                        "fecha" => "2002"
                        "volumen" => "22"
                        "paginaInicial" => "S103"
                        "paginaFinal" => "S116"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12376604"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Traumatic diaphragmatic hernia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B&#46;M&#46; Carter"
                            1 => "J&#46; Giuseffi"
                            2 => "F&#46; Felson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "AJR Am J Roentgenol"
                        "fecha" => "1951"
                        "volumen" => "65"
                        "paginaInicial" => "56"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Traumatic lesions of the diaphragm"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:8 [
                            0 => "F&#46; Stagnitti"
                            1 => "F&#46; Priore"
                            2 => "F&#46; Corona"
                            3 => "R&#46; Tiberi"
                            4 => "M&#46; De Pascalis"
                            5 => "F&#46; Schillaci"
                            6 => "A&#46; Costantini"
                            7 => "E&#46; Natalini"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "G Chir"
                        "fecha" => "2004"
                        "volumen" => "25"
                        "numero" => "8-9"
                        "paginaInicial" => "276"
                        "paginaFinal" => "282"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15560301"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Traumatic rupture of the diaphragm&#58; experience with 65 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:8 [
                            0 => "P&#46; Mihos"
                            1 => "K&#46; Potaris"
                            2 => "J&#46; Gakidis"
                            3 => "J&#46; Paraskevopoulos"
                            4 => "P&#46; Varvatsoulis"
                            5 => "B&#46; Gougoutas"
                            6 => "G&#46; Papadakis"
                            7 => "E&#46; Lapidakis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Injury"
                        "fecha" => "2003"
                        "volumen" => "34"
                        "numero" => "3"
                        "paginaInicial" => "169"
                        "paginaFinal" => "172"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12623245"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
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