Actividad donación-trasplante. Hospital Universitario de Son Dureta. 1989-2003

España es el país con la tasa (n° por millón de población) de donaciones y trasplantes de órganos sólidos mayor del mundo. El Hospital Universitario de Son Dureta (HUSD) ha contribuido de forma progresiva e importante a esta actividad desde 1989. El éxito de esta actividad de donación-trasplante de órganos depende del trabajo en equipo de muchos profesionales sanitarios y no sanitarios del hospital y de la Comunidad, con diferentes características y motivaciones. Es como una cadena con múltiples eslabones que no se pueden romper, con una finalidad común y única, que es la extracción de órganos, de pacientes que han evolucionado a la muerte a pesar de nuestros esfuerzos terapéuticos, para su posterior trasplante a pacientes que están en la fase terminal o irreversible de sus enfermedades. Sin un personal sanitario concienciado sobre la importancia de la donación de órganos, es difícil sacar adelante los procesos hospitalarios de donación-trasplante. Actualmente el HUSD esta plenamente identificado con la actividad de donación-trasplante de órganos, después de muchos años de trabajo, esfuerzo e ilusión. Esta actividad médica tiene un componente humano importante, tanto para las familias de los donantes con las que se mantiene un vínculo muy especial, como para los pacientes que están esperando algún órgano. El éxito profesional y social de esta actividad supone un prestigio para todos los profesionales que trabajamos en el HUSD, sus unidades generadoras de donantes y la Comunidad Balear

Pentobarbital versus thiopental in the treatment of refractory intracranial hypertension in patients with traumatic brain injury: a randomized controlled trial

Introduction: Experimental research has demonstrated that the level of neuroprotection conferred by the various barbiturates is not equal. Until now no controlled studies have been conducted to compare their effectiveness, even though the Brain Trauma Foundation Guidelines recommend that such studies be undertaken. The objectives of the present study were to assess the effectiveness of pentobarbital and thiopental in terms of controlling refractory intracranial hypertension in patients with severe traumatic brain injury, and to evaluate the adverse effects of treatment. Methods: This was a prospective, randomized, cohort study comparing two treatments: pentobarbital and thiopental. Patients who had suffered a severe traumatic brain injury (Glasgow Coma Scale score after resuscitation ≤ 8 points or neurological deterioration during the first week after trauma) and with refractory intracranial hypertension (intracranial pressure > 20 mmHg) first-tier measures, in accordance with the Brain Trauma Foundation Guidelines. Results: A total of 44 patients (22 in each group) were included over a 5-year period. There were no statistically significant differences in ' baseline characteristics, except for admission computed cranial tomography characteristics, using the Traumatic Coma Data Bank classification. Uncontrollable intracranial pressure occurred in 11 patients (50%) in the thiopental treatment group and in 18 patients (82%) in the pentobarbital group (P = 0.03). Under logistic regression analysis - undertaken in an effort to adjust for the cranial tomography characteristics, which were unfavourable for pentobarbital - thiopental was more effective than pentobarbital in terms of controlling intracranial pressure (odds ratio = 5.1, 95% confidence interval 1.2 to 21.9; P = 0.027). There were no significant differences between the two groups with respect to the incidence of arterial hypotension or infection. Conclusions: Thiopental appeared to be more effective than pentobarbital in controlling intracranial hypertension refractory to first-tier measures. These findings should be interpreted with caution because of the imbalance in cranial tomography characteristics and the different dosages employed in the two arms of the study. The incidence of adverse effects was similar in both groups

Diagnóstico antenatal de la madurez pulmonar fetal en embarazos normales y patológicos

Hemos realizado un estudio de madurez fetal, en muestras de líquido amniótico obtenido en 112 mujeres en las que el parto se produjo antes de transcurridos 7 días tras la amniocentesis. Comparamos el test de Clements, el estudio de células naranaja, la DO a 650 y 400 NM y la determinación de creatinina, con el cociente lecitina/ esfingomielina. El test de Clements y la determinación de DO presentan una buena correlación con el cociente L/E

Traumatic brain injury and acute kidney injury - outcomes and associated risk factors

Our objective was to analyze the contribution of acute kidney injury (AKI) to the mortality of isolated TBI patients and its associated risk factors. Observational, prospective and multicenter registry (RETRAUCI) methods were used, from March 2015 to December 2019. Isolated TBI was defined as abbreviated injury scale (AIS) ≥ 3 head with no additional score ≥ 3. A comparison of groups was conducted using the Wilcoxon test, chi-square test or Fisher's exact test, as appropriate. A multiple logistic regression analysis was conducted to analyze associated risk factors in the development of AKI. For the result, overall, 2964 (30.2%) had AIS head ≥ 3 with no other area with AIS ≥ 3. The mean age was 54.7 (SD 19.5) years, 76% were men, and the ground-level falls was 49.1%. The mean ISS was 18.4 (SD 8). The in-hospital mortality was 22.2%. Up to 310 patients (10.6%) developed AKI, which was associated with increased mortality (39% vs. 17%, adjusted OR 2.2). Associated risk factors (odds ratio (OR) (95% confidence interval)) were age (OR 1.02 (1.01?1.02)), hemodynamic instability (OR 2.87 to OR 5.83 (1.79-13.1)), rhabdomyolysis (OR 2.94 (1.69-5.11)), trauma-associated coagulopathy (OR 1.67 (1.05-2.66)) and transfusion of packed red-blood-cell concentrates (OR 1.76 (1.12-2.76)). In conclusion, AKI occurred in 10.6% of isolated TBI patients and was associated with increased mortality