Subject(s)
Death , Liver Transplantation , Tissue Donors , Tissue and Organ Harvesting/methods , Tissue and Organ Procurement , Brain Ischemia/complications , Carcinoma, Hepatocellular/surgery , Cerebral Hemorrhage/complications , Female , Glucose , Heart Arrest/diagnosis , Heart Arrest/etiology , Humans , Liver Cirrhosis, Alcoholic/surgery , Liver Neoplasms/surgery , Male , Mannitol , Middle Aged , Organ Preservation/methods , Organ Preservation Solutions , Potassium Chloride , Practice Guidelines as Topic , Procaine , Tissue Donors/supply & distribution , Tissue and Organ Procurement/standards , Treatment OutcomeABSTRACT
La utilización clínica de tejidos humanos es una realidad terapéutica para numerosas enfermedades, y en los últimos años se ha asistido a un espectacular aumento en su demanda. Esto ha generado paralelamente un incremento en la demanda de donantes, que en el caso de la obtención de tejidos no está limitado al donante en muerte encefálica. Consecuentemente, se debe potenciar la obtención de tejidos humanos procedentes de donantes en parada cardior respiratoria en nuestros centros. Con esta finalidad, presentamos la experiencia desarrollada en nuestro centro en los últimos 5 años, así como los mecanismos que pusimos en marcha para lograr los objetivos deseados. Durante este periodo se desarrolló una campaña de sensibilización e información del personal sanitario de las áreas de críticos, urgencias y hemodinámica. El siguiente paso será ampliar esta campaña al resto del personal sanitario del centro. Pensamos que los mecanismos para que el personal sanitario colabore en la detección de posibles donantes multitejidos pasan por la información actualizada sobre las indicaciones y las ventajas terapéuticas que ofrecen la utilización clínica de tejidos humanos, favoreciendo la concienciación hospitalaria en esta materia y, por lo tanto, la detección del donante potencial (AU)
Abstract The clinical use of human tissues is a therapeutic reality in many diseases, observing a spectacular increase in their demand in recent years. This has also generated an increase in the demand for donors which, in regarding to obtaining tissues, is not limited to brain death donors. Consequently, tissues obtained from cardiorespiratory arrest donors must be promoted in our hospitals. With this purpose, we present our experience in the last five years and the mechanisms we used to reach these goals. During this period, an awareness and health care staff information campaign was carried out in the Emergency and Hemodynamic areas. The next step will be to extend this campaign to the rest of the hospital staff (AU)
Subject(s)
Humans , Young Adult , Adult , Middle Aged , Aged , Tissue and Organ Procurement , Tissue Donors , Tissue and Organ Procurement/methods , Tissue and Organ Procurement/standardsABSTRACT
The clinical use of human tissues is a therapeutic reality in many diseases, observing a spectacular increase in their demand in recent years. This has also generated an increase in the demand for donors which, in regarding to obtaining tissues, is not limited to brain death donors. Consequently, tissues obtained from cardiorespiratory arrest donors must be promoted in our hospitals. With this purpose, we present our experience in the last five years and the mechanisms we used to reach these goals. During this period, an awareness and health care staff information campaign was carried out in the Emergency and Hemodynamic areas. The next step will be to extend this campaign to the rest of the hospital staff. We believe that the mechanisms needed to obtain hospital staff collaboration in the detection of multi-tissue donors is to offer updated information on the indications and therapeutic advantages of clinical use of human tissues, favoring hospital awareness on this subject and therefore the detection of potential donors.
Subject(s)
Tissue Donors , Tissue and Organ Procurement , Adult , Aged , Humans , Middle Aged , Tissue and Organ Procurement/methods , Tissue and Organ Procurement/standards , Young AdultABSTRACT
Rhabdomyolysis is a syndrome characterized by injure of skeletal muscle with the release of intracellular constituents into the circulation. Acute renal failure is a common complication and is the leading cause of morbidity and mortality in these patients. The most common aetiology is traumatisms, muscle compressions and extreme exertions. Most commonly, the cause of rhabdomyolysis is evident from the careful clinical history. Nevertheless, when the precipitant is not obvious the diagnosis is difficult and a raised clinical suspicion is required. We should investigate used medication or drugs, infections, electrolyte abnormalities and a number of inherited enzyme deficiencies, in which cases the muscle is unable to use available energy. We report two clinical cases of acute renal failure due to rhabdomyolysis by metabolic myopathies due to a carnitine palmitoyltransferase deficiency on the one hand and by myophosphorylase deficiency on the other. We describe their clinical features and progress.
Subject(s)
Carnitine O-Palmitoyltransferase/deficiency , Glycogen Phosphorylase, Muscle Form/deficiency , Rhabdomyolysis/etiology , Acute Kidney Injury/etiology , Adult , Humans , Male , Rhabdomyolysis/complicationsABSTRACT
BACKGROUND: To establish the relation between class I and II HLA antigens, systemic lupus erythematosus (SLE), autoantibodies production, and clinical manifestations in the south of Spain (Málaga). METHODS: In a regional hospital we undertook a case-control study with a consecutive sample of 104 patients with SLE who fulfilled at least 4 criteria of ARA. Three hundred and twenty-eight local controls with no apparent pathology were included for comparison. We evaluated clinical and analytical aspects about multisystem autoimmune disease. HLA typing was serologically determined. RESULTS: Univariate analysis showed a relation between SLE and the specificities B8 (21% of patients vs 10% of controls, p = 0.005; RR = 2.3), DR3 (36% vs 20%, p = 0.0006; RR = 2.5), DRw52 (69% vs 49%, p = 0.001; RR = 2.3), and DQ2 (49% vs 36%, p = 0.0150; RR = 1.7). However, in logistic regression multivariate analysis, there was a confounding effect between DR3 and DRw52, and it could be that only this specificity, HLA-DRw52 (RR = 2.0; 95% CI: 1.1-4.0), and of lesser degree B8 (RR = 1.9; 95% CI: 0.9-4.4), are really associated with SLE. Also, in multivariate analysis, DR6 showed a negative association (5% vs 25%, p = 0.011; RR = 4.2; 95% CI: 1.5-17.2) with anti-U1RNP, while DRw52 showed a negative association with IgG-aCL (50% vs 85%, p = 0.019; RR = 0.21; 95% CI: 0.06-0.76). Furthermore, DQ2/DQ6 showed positive association with anti-SSA/Ro antibodies (50% vs 24%; p = 0.046; RR = 3.0; 95% CI: 1.0-9.0). There were also several associations between clinical manifestations and HLA. The specificities DR and DRw53 were almost always risk factors, but only DR5 was a protector for renal lesion. DRw52 and DQ specificities were always protectors when they were associated with some clinical manifestations. Isolated DR3 antigen, is not associated with any of the above-mentioned manifestations. CONCLUSIONS: The previously described relation between SLE and the antigen DR3 is confirmed, but this association could be a result of the presence of DRw52 specificity in patients, that is in linkage disequilibrium with DR3.
