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      Los estudios sobre el riñón y la circulación renal de Josep Trueta i Raspall: 1897-1977 Translated title: Studies on the kidney and the renal circulation, by Josep Trueta I Raspall: 1897-1977

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          Abstract

          Introducción: Josep Trueta i Raspall, nacido en Barcelona en 1897, fue uno de los más destacados cirujanos de su tiempo. Después de iniciada la rebelión militar y la guerra de 1936, se hace cargo de la cirugía en el Hospital de la Santa Creu y Sant Pau y pone en práctica un método de cura oclusiva de las fracturas abiertas, que disminuye dramáticamente el número de gangrenas y amputaciones entre civiles y militares. Con el final de la guerra y el exilio, es invitado por el servicio de salud inglés, en Oxford enseña sus conocimientos de cirugía de guerra, es nombrado doctor honoris causa y profesor de ortopedia, y crea una escuela de investigación clínica que genera importantes hallazgos en el desarrollo y patología del hueso y, entre otras áreas, en el conocimiento de la función renal y las lesiones renales inducidas por el shock y la hipertensión arterial. Uno de los frutos más destacados de esta investigación es el libro "Estudios sobre la circulación renal", publicado en inglés en 1947 (Oxford) y en castellano en 1949 (Barcelona). Material y Método: Estudio de la biografía de Josep Trueta y análisis de sus trabajos sobre la función renal, en especial del texto "Estudios sobre la circulación renal", relacionándolo con el estado de los estudios nefrológicos en su tiempo. Resultados: Trueta y su grupo fueron pioneros en el estudio de las causas de la oliguria postraumática de los heridos de guerra. Basándose en los primeros estudios sobre el síndrome de aplastamiento, publicados en 1941, en los que se señalaba el fallo renal que seguía a las lesiones extensas de los miembros, demuestran los cambios en la circulación renal consecutivos a diferentes lesiones de los miembros, como isquemia, hemorragia e infecciones. "Estudios sobre la circulación renal" y otros textos publicados en revistas de gran impacto, exponen la isquemia cortical renal con preservación o aumento de la circulación medular y yuxtamedular que tiene lugar en estos estados patológicos. Aunque sus aportaciones y las hipótesis que aventuró, no fueron definitivas, sirvieron de base para otros estudios realizados años después sobre la insuficiencia renal aguda secundaria al shock, la glomerulonefritis, el rechazo del trasplante y la hipertensión arterial. Comentario: Los trabajos de Trueta son un extraordinario ejemplo de investigaciones dirigidas a responder a preguntas clínicas concretas. Llama la atención el amplio campo de investigación en que se mueve, que hoy día implicaría a diversas especialidades muy ajenas a sus tareas de cirujano ortopeda. Además de su pasión catalanista, que le movió a escribir "The spirit of Catalonia" (1946), un breve texto sobre la historia de Cataluña para el público de habla inglesa, Trueta fue un intelectual humanista con intereses muy amplios, que dejó reflejados en sus libros de viajes, y en textos sobre la vida de sabios clásicos como Luis Vives, Miguel Servet o Cajal. Regresó a Cataluña en 1966 y falleció en 1977. Su libro "Estudios sobre la circulación renal", exquisitamente ilustrado y editado, merece un lugar destacado en la historiografía médica de interés urológico.

          Translated abstract

          Introduction: Josep Trueta i Raspall, born in Barcelona in 1897, was one of the most outstanding european surgeons of his time. In 1936, after the military coup and during the subsequent Spanish civil war, he was in charge of the Surgery Service at the Hospital de la Santa Creu y Sant Pau and begins to performe a closed method to treat open fractures of the limbs, dramatically lowering the number of gangrenes and amputations between troops and civilians. At the end of the war came the exile, and he was invited by the british Health Service, he teach in Oxford and applies his knowledge on war surgery, was named PhD (Hon) and professor of ortopedics, and creates an school of clinical investigation that generates important findings in bone growing and pathology and, amont other areas, in the knowledge of renal function and kidney injuries induced by shock and blood hypertension. One of the most outstanding fruits of this investigation is the book "Studies on renal circulation", first published in English in 1947 (Oxford), then in Spanish in 1949 (Barcelona). Material and Method: Study of Josep Trueta’s biography and works on kidney function, especially the book "Studies on the renal circulation", relating them to the state-of- the- art of nephrologic studies of his time. Results: Trueta and his group were pioneers in the study of the causes of postraumatic oliguria in war wounds. On the basis of the first studies on crush syndrome, published in 1941, were the kidney failure that followed the extended injuries of the limbs was pointed out, they could demonstrated the changes in renal circulation that followed different injuries to the limbs, such as ischemia, haemorrhage and infections. "Studies on the renal circulation" and other papers published in journals of high scientific impact, shown the renal cortical ischemia with preservation or increase of the medullar and yuxtamedullar circulation that takes place in those pathological situations (Trueta shunt). Although their contributions and hypothesis were not definitives, they served as the basis to studies performed later on, on acute kidney failure secondary to shock, glomerulonephritis, transplant rejection and blood hypertension. Comment: Trueta’s works are unusual examples of investigations directed to answer clinical questions. What may calls one’s attention is the wide field of investigation he moves on, that today would involved several medical specialities, different to his task as orthopedic surgeon. On the other hand, his love by Catalonia, his country, moves him to write "The spirit of Catalonia" (1946), a short text for English-speaking people, on the political and scientific history of Catalonia. Trueta was in the end, an humanistic intellectual with broad interests, reflected on his books on travels or on the life of classic sages such as Luis Vives, Miguel Servet or Cajal. He returned back to Catalonia in 1966 and died in 1977. His book "Studies on the renal circulation", exquisitely illustrated and edited deserves a distinguished place in the European medical and urological historiography.

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          Most cited references 25

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          The acute vascular response to intramedullary reaming. Microsphere estimation of blood flow in the intact ovine tibia.

          The tibial nutrient artery supplies 62% of cortical blood flow in the diaphysis and normal blood flow is centrifugal (Willans 1987). Intramedullary reaming destroys the nutrient artery and injures the endosteal surface of the cortex. Trueta (1974) suggested that the direction of blood flow can reverse from centrifugal to centripetal after loss of the endosteal supply. We examined this hypothesis by measuring cortical and periosteal blood flow after intramedullary reaming of the tibia in eight sheep, using 57Co radiolabelled microspheres. The unreamed contralateral tibiae served as a control group. Thirty minutes after reaming there was no significant change in cortical blood flow, but a sixfold increase in the periosteal flow. Our study confirms Trueta's hypothesis; after trauma or in other pathological states, flow can become centripetal.
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            Arterial spasm an experimental study

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              Discussion on renal circulation.

               A Barclay,  J Trueta (1948)
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                Author and article information

                Contributors
                Role: ND
                Journal
                aue
                Actas Urológicas Españolas
                Actas Urol Esp
                Asociación Española de Urología (, , Spain )
                0210-4806
                March 2008
                : 32
                : 3
                : 276-280
                Affiliations
                Vigo orgnameHospital Povisa orgdiv1Servicio de Urología
                Article
                S0210-48062008000300003
                10.4321/s0210-48062008000300003

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

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