El arco axilar de Langer: una variación anatómica con importancia quirúrgica / No disponible

El arco muscular de Langer es la variación anatómica muscularmás frecuente de la axila, y su existencia puede llegar acondicionar el resultado de gestos diagnósticos y terapéuticosrelevantes, como es el caso de la linfadenectomía. También seha relacionado con cuadros clínicos derivados de la compresiónde estructuras neurovasculares de la axila. Presentamosdos casos de arco axilar y se realizan consideraciones anatómicas,clínicas y diagnósticas que apoyan la importancia de estaestructura desde el punto de vista quirúrgico(AU)

The muscular arch of Langer is the most common anatomicalmuscular variation in the axilla, the existence of whichmay condition the result of relevant diagnostic and therapeuticinterventions, such as in the case of lymphadenectomy. It hasalso been related to clinical features derived from the compressionof neurovascular structures in the axilla. We present twocases of axillary arch and address anatomical, clinical and diagnosticissues to support the importance of this structure from asurgical point of view(AU)

Primary health care personnel faced with cadaveric organ donation: a multicenter study in south-eastern Spain.

INTRODUCTION: Primary health care (PHC) is the first point of contact between the public and the health system and it is an important channel for the communication and promotion of organ donation and transplantation. The objective of this study was to analyze the attitude of PHC personnel toward donation and to determine the psychosocial variables affecting this attitude. MATERIALS AND METHODS: A random sample was stratified by job category and geographical location among PHC personnel (n = 482) from 32 health centers. Attitude was evaluated using a questionnaire validated in our local area. (It was completed anonymously and was self-administered.) RESULTS: The questionnaire completion rate was 86% (n = 414): 78% (n = 325) are in favor and the remaining 22% (n = 89) are either against or are not sure. The reason given for a negative attitude is fear of apparent death (16%; n = 14). There are many independent factors that affect attitude: (i) job category (OR = 2.4); (ii) knowledge of the concept of brain death (OR = 2.2); (iii) a preference for alternatives to burial (OR = 2.99); (iv) being in favor of cremation (OR = 01.87) and (v) knowledge of the attitude of one's partner toward organ donation (OR = 0.312). CONCLUSION: PHC personnel have a favorable attitude toward donation, especially physicians, although it would be useful to provide more information to PHC personnel. Physicians could be a key element in the direct and indirect promotion of donation and transplantation.

Fibroadenoma en tejido mamario ectópico axilar / No disponible

La aparición de un tumor axilar obliga a realizar el diagnósticodiferencial con diversas entidades benignas y malignas. Laexistencia de tejido mamario ectópico en la axila es uno de loscuadros benignos que se deben considerar. Más infrecuente esencontrar patología asociada a ese tejido de localización anómala.En este trabajo presentamos el caso de una pacientecon un fibroadenoma dependiente de una glándula axilar ectópica(AU)

An axillary tumour appearance forces to do a differential diagnosisamong several benign and malignant entities. Axillaryectopic breast is one of the benign processes to be considered.Related pathology to this anomalous localised tissue is a moreinfrequent event. In this work we present a case of fibroadenomainside axillary ectopic breast gland(AU)

Hospital personnel in surgical services in a transplant hospital faced with living liver donation: an attitudinal survey.

UNLABELLED: Living liver donation is becoming a more widely accepted practice given the decrease in donor morbidity and mortality and the beneficial results in the recipient. Use of this technique is unusual in Spain. There are a number of workers against its use within the health care system. The objective of this study was to analyze attitudes toward and the variables that affect them concerning living liver donation among surgical services in a transplant hospital. MATERIALS AND METHODS: A random survey was stratified by surgical area and job category in a Spanish third-level hospital with an ongoing solid organ transplant program. Attitudes toward living liver donation were assessed using a questionnaire about organ donation and transplantation that evaluated various psychosocial variables. Student's t test and the chi square test were used. RESULTS: A total of 263 workers were surveyed (mean age as 40 +/- 9 years). Regarding attitudes toward living liver donation, the level of acceptance was 80% (n = 211) of respondents, whereas 10% were undecided (n = 26), and another 10% were against (n = 26), assuming that the donations were related. When we asked about unrelated living donation, the percentage in favor decreased to 10% (n = 27). No differences were found with respect to job category or type of service. The variables that are related to such an attitude are the following: (1) possibility of respondent needing an organ (P = .001); (2) favorable attitude toward living kidney donation (P < .000); and (3) a belief that medical errors exist (P = .004). An important finding was that attitudes toward living liver donation were not more favorable according to whether the respondent was in favor or against cadaveric organ donation (P = .175). CONCLUSION: There was a highly favorable attitude toward living liver donation among hospital personnel in surgical services, which is an important factor to take into account if this type of donation is to be encouraged in Spain.

Attitude of hospital personnel faced with living liver donation in a Spanish center with a living donor liver transplant program.

In Spain, despite its high rate of cadaveric donation, death while on the liver transplant waiting list is high. For this reason, living liver donation is being encouraged despite of the risk of morbidity for the donor. The objective of this study was to analyze attitudes toward living liver donation among hospital personnel in a hospital with a recently authorized living donor liver transplantation program. A random sample was taken and was stratified by type of service and job category (n = 1,262). Attitude was evaluated by means of a validated psychosocial questionnaire. The questionnaire was completed anonymously and was self-administered. Statistical analysis included the Student t test, the chi(2) test, and logistical regression analysis. The questionnaire completion rate was 93% (n = 1,168). Only 15% (n = 170) of respondents were in favor of living liver donation if it were unrelated. An additional 65% (n = 766) were in favor if this donation, but only for relatives. Of the rest, 9% (n = 107) did not agree with living liver donation, and the remaining 11% (n = 125) were undecided. The variables related to this attitude were age (P = 0.044); job category (P = 0.002); type of service (according to whether it is related to organ donation and transplantation) (P = 0.044); participation in prosocial activities (P = 0.026); attitude toward cadaveric organ donation (P <0.001); attitude of a respondent's partner toward organ donation (P = 0.010); a respondent's belief that in the future, he or she may need a transplant (P < 0.001); and a willingness to receive a donated living liver organ if one were needed (P < 0.001). There is also a close relationship between attitude toward living kidney donation and living liver donation (P < 0.001). In the multivariate analysis, the only common independent variable from the bivariate analysis was a willingness to receive a living donor liver transplant if one were needed (odds ratio = 9.3). Attitude toward living liver donation among hospital personnel in a hospital with a solid organ transplant program is favorable and is affected by factors related to cadaveric donation, altruistic activity, and feelings of reciprocity. Physicians and the youngest hospital workers are those who are most in favor, which leads us to think that there is a promising future for living liver transplantation, which is essential given the cadaveric organ deficit and the high mortality rate while on the waiting list.

Fístula quilosa postlinfadenectomía axilar / No disponible

Dentro de las complicaciones de la linfadenectomía axilar,el diagnóstico de una fístula quilosa es un hecho excepcionalque puede interferir con el manejo posterior de lospacientes, especialmente en aquellos casos oncológicos queprecisan tratamientos adyuvantes. Se presenta un caso clínicode fístula quilosa postlinfadenectomía axilar por cáncerde mama. Se realiza una revisión de la literatura y se comentandiversos aspectos de su patogenia, diagnóstico ytratamiento

The diagnosis of a chylous fistula is an exceptional eventamong the complications of axillary lymphadenectomy thatcan interfere with the management of these patients, speciallythose oncologic cases that need adjuvant treatments. We presenta case of chylous fistula secondary to axillary postlymphadenectomyin the treatment of a breast cancer. A literaturereview is made and we comment about several aspects of itspatogeny, diagnosis and management (AU)

Factors causing early relapse after lung metastasis surgery.

Haematogenous lung metastases are usually considered a sign of widespread metastatic disease. However, in most primary cancers, the first filter for distant tumours are the lungs. In some patients, the metastatic process may stop at the lungs. In these selected patients, there are studies that have shown the benefits of metastasectomy. The objective of this paper is to analyse the morbidity and mortality of lung metastasectomy and determine the factors that predispose to early relapse. Forty-two patients operated on for lung metastases, and four were excluded as they were assessed intraoperatively to be unresectable, leaving 38 patients to be analysed. The variables analysed were: age, sex, primary tumour, disease-free interval, number of metastases, bilaterality, morbidity and mortality, relapse, reinterventions, relapse-free interval after metastasectomy and survival. The surgical technique was a posterolateral thoracotomy, and there were no perioperative deaths. Morbidity was 11% (n = 4), and surgical reintervention of the haemothorax was necessary. Survival after 1, 2 or 3 years was 87%, 61% and 25% respectively, and the percentage of relapse-free patients was 71%, 56% and 17% respectively. The main factors associated with early relapse were histological type of tumour (more relapse in sarcoma, and less in adenocarcinoma), the disease-free interval between the primary tumour and lung metastases, and the number of metastases. Surgery was required a second time in five patients who had relapsed lung metastases, but extirpation could be performed in only four patients, of whom three were relapse free after 6, 12 and 24 months respectively, and the fourth had relapsed lung metastases after 18 months. Resection of lung metastases can be performed with low morbidity and mortality. The main prognostic factors for survival are complete surgery, histological type, disease-free interval between the primary tumour and metastases, and the number of lung metastases.

Angiosarcoma de mama postradioterapia ¿un tumor de importancia creciente? / No disponible

El angiosarcoma postradioterapia es un tumor raro que surgeasociado al tratamiento conservador del cáncer de mama.Es preciso diferenciarlo de otras formas de angiosarcoma relacionadoscon la mama como son el angiosarcoma primario yel síndrome de Stewart-Treves. Suelen presentarse como sarcomasde alto grado localizado en la piel o tejido subcutáneoy con menos frecuencia en el parénquima mamario. Tienenun periodo de latencia variable aunque inferior al de otros sarcomasradioinducidos. El único tratamiento curativo es la cirugía,si bien la elevada tendencia a la recurrencia de estos tumoreshace que la cirugía radical no sea capaz de prevenir lareaparición de la enfermedad en muchos casos. Presentamosdos casos de angiosarcoma radioinducido con distinta evolucióntras su tratamiento(AU)

Postradiation angiosarcomas are infrequent tumours thatarise associated to conservative treatment of breast cancer. Itis needed to distinguish between them and other types of breastangiosarcomas like primary angiosarcoma or Stewar-Trevessyndrome. They usually present as high grade sarcomaslocated at skin or subcutaneous tissue and less frequent in breastparenchyma. They have a variable latency time that is lowerthan the other radioinduced sarcomas. Surgery is the onlycurative treatment although the high relapse rate makes thatradical surgery is not be able to prevent the recurrence in mostcases. We present two cases of radioinduced angiosarcomawith different outcome after their treatment(AU)

Leiomioma del pezón en varón / No disponible

El leiomioma del pezón es un tumor muy poco frecuente,que suele ser de pequeño tamaño y silente, aunque cuandoprovoca clínica es en forma de dolor o prurito. Cuando se sospechaes conveniente su extirpación para su diagnóstico ypara eliminar los síntomas cuando los haya. La inmunohistoquímicacon actina confirma su origen en las células musculareslisas. Su pronóstico es excelente aunque puede recidivar,por lo que la exéresis debe ser completa. Presentamos el casode un leiomioma del pezón en un varón(AU)

Leiomyoma of the nipple is a rare or sheldon tumor withsmall size that usually it do not causes symptoms it causesthem, it is like pain or pruritus. A conservative excision is indicatedfor tissue examination and for treating the possiblesymptoms. The immunohistochemical study with actin confirmsits smooth-muscle origin. It has a good prognosis butthere can appear recurrences, so the excision must be complete.We present the case of a man with a leiomyoma of thenipple(AU)

El personal no sanitario de un hospital español con programa de trasplantes ante la donación de vivo hepática / Ancillary personnel faced with living liver donation in a Spanish hospital with a transplant program

Introducción: los profesionales no sanitarios de centros hospitalarios representan un grupo de opinión importante,pues por el hecho de trabajar en un centro hospitalario su opinión tiene credibilidad entre la población, y sin embargo no tienen la preparación ni formación sanitaria en la mayoría de casos, lo cual hace que su actitud pueda estar basada en el desconocimiento o miedos no fundados. El objetivo es analizar la actitud hacia la donación hepática de vivo de los profesionalesno sanitarios de un hospital con programa de trasplante de órganos de cadáver y de donante vivo hepático, y analizar las variables que influyen en dicha actitud.Pacientes y método: muestra aleatoria y estratificada porservicio (n = 401) entre el personal no sanitario del hospital. La actitud se valoró mediante una encuesta validada en nuestro medio. Para su distribución se contactó en cada servicio con el representante del mismo al cual se le explicó el estudio y fue el responsable del reparto del cuestionario en los turnos seleccionados.La encuesta fue cumplimentada de forma anónima yautoadministrada. Estadística: test de Chi cuadrado, t de Student y análisis de regresión logística.Resultados: el grado de cumplimentación del cuestionariofue del 94% (n = 377). De los encuestados, el 20% (n = 74) está a favor de la donación de vivo de un hemi-hígado tanto relacionada como no relacionada, porcentaje que asciende hasta el 82% (n = 307) si la donación fuera relacionada. Del resto, el 8% (n = 30) no acepta dicha donación y el 11% (n = 40) restante está indeciso. Al analizar las variables que se relacionan con la actitud hacia la donación de vivo hepática se obtienen: laactitud hacia la donación de cadáver (p = 0,002), el creer el encuestado en la posibilidad de necesitar un trasplante en el futuro (p < 0,001) y en dicho caso la aceptación de un hígado de donante vivo (p < 0,001). Al realizar el análisis multivariante persisten ambas: a) el creer el encuestado en la posibilidad de necesitar un trasplante en un futuro (OR = 1,5); y b) en dicho caso la aceptación de un riñón de donante vivo (OR = 16,2).Conclusiones: la actitud hacia la donación de vivo hepática entre el personal no sanitario de un hospital trasplantador es bastante favorable, y no está condicionada por los factores psico-sociales descritos previamente asociados a la actitud hacia la donación. Sin embargo, si se quiere potenciar este tipo de trasplante con donante vivo es necesario continuar con la realización de campañas de información y concienciación hospitalaria

Introduction: ancillary hospital personnel represent an important body of opinion because as they work in a hospital their opinion has more credibility for the general public as a result of their activity in hospitals. However, in most cases they do not have any health care training which means that their attitude could be based on a lack of knowledge or unfounded fears. The objective of this study is to analyze the attitude toward living liver donation among ancillary personnel in a hospital with a cadaveric and living liver organ transplant program and to analyze the variables that might influence such attitude. Patients and method: a random sample was taken which was stratified by service (n = 401) among ancillary personnel in the hospital. Attitude was evaluated using a survey that was validated in our geographical area. A representative from each service was contacted. This person was given an explanation of the study and was made responsible for the distribution of the questionnaire in selected work shifts. The survey was completed anonymously and was self-administered. The X2 test, Student’s ttest and logistical regression analysis were used in the statistical analysis. Results: the questionnaire completion rate was 94% (n = 377). Of all the respondents, 20% (n = 74) are in favor of donating a living hemi-liver, but an additional 62% (n = 233) are in favor if donation is for a relative. Of the rest, 8% (n = 30) do not accept this type of donation and the remaining 11% (n = 40) are unsure. The following variables are related to attitude toward living liver donation: attitude toward cadaveric donation (p = 0.002); a respondent’s belief that he or she might need a transplant in the future (p < 0.001) and a willingness to receive a donated living liver if one were needed (p < 0.001). In the multivariate analysis the following have been found to be significantly related variables: a) a respondent’s belief that he or she might need a transplant in the future (OR = 1.5); and b) a willingness to receive a living donated kidney if one were needed (OR = 16.2). Conclusions: attitude toward living liver donation is fairly favorable among ancillary personnel in a transplant hospital and is not affected by the psychosocial factors found to be related to attitude toward donation in previous studies. However, if we want to encourage this type of transplantation with living donors it will be necessary to carry out informative campaigns to raise awareness within the hospital

What is the attitude of hospital transplant-related personnel toward donation?

The attitude of health-care workers, especially in transplant-related services, is fundamental in the process of organ procurement. In this study we examine the attitude of workers in transplant-related services toward cadaveric organ donation and transplantation (ODT) in a third-level hospital in Spain. A random sample was stratified according to type of service and job category (n = 309) among personnel in transplant-related services (organ procurement units, transplant units and follow-up units). Attitude toward cadaveric organ donation was evaluated using a validated psychosocial questionnaire. Seventy percent (n = 215) of respondents were found to be in favor of donation, as opposed to 30% against or undecided (n = 94). Regarding job category, attitude was most favorable among physicians (86%, n = 99; p = 0.000). With respect to type of service, attitude tended to be more negative in organ procurement units and more positive in the follow-up units of transplanted patients (41% vs 81%, p = 0.013). Upon analysis of the psychosocial variables, significant results were found with respect to the following factors: (1) age (39 vs 42 years, p = 0.007); (2) having discussed ODT with family members or with a partner (p = 0.007); (3) understanding of the concept of brain death (p = 0.001); (4) attitude toward carrying out an autopsy (p = 0.001); and (5) concern about the possibility of mutilation after organ extraction. Attitude toward cadaveric donation was lower than expected among personnel in transplant-related services, especially among ancillary personnel and workers in organ procurement units.

Hospital personnel faced with organ xenotransplantation: an attitudinal survey in a hospital with a pre-clinical liver xenotransplantation program.

BACKGROUND: In situations of extreme urgency when there is a need for vital organs, xenotransplantation could provide a bridge until the arrival of a human organ. However, it is important to find out the level of acceptance of this potential therapy among the health care workers who would be involved in its implementation. The objective of this study is to analyze attitude among personnel in a hospital with a pre-clinical xenotransplantation program toward xenotransplantation and to determine the variables that influence this attitude. MATERIALS AND METHODS: A random sample (n=1168) was taken and stratified according to job category and service. Attitude toward xenotransplantation was evaluated using a validated questionnaire. Contact was made with the head of each service who was given an explanation of the project. This person was made responsible for the distribution and collection of the survey in each service in randomly selected work shifts. Such a survey was completed anonymously and was self-administered. A random sample of 250 individuals from our regional community was used as a control group. RESULTS: The survey completion rate was 98% (n=1148). Most respondents are in favor (67%), 7% are against and 26% undecided. Such an attitude is more favorable in the control group (74% vs. 67%; P=0.0378). The following factors are positively related to such an attitude: (1) male sex (P<0.0005); (2) a younger age (P=0.013); (3) participation in prosocial voluntary activities (P=0.002); (4) knowing that the church has a positive attitude toward donation and transplantation (P<0.0005); (5) a partner's favorable attitude toward transplantation (P<0.0005); (6) a physician's job category (P<0.0005); (7) a resident physician's job contract situation (P=0.017); (8) a respondent's belief that he or she may need a transplant in the future (P<0.0005); and (9) a favorable attitude toward human donation, whether this be cadaveric or living (P<0.0005). In the multivariate analysis, the following persist as independent variables: (1) sex (odds ratio=1.6); (2) participation in prosocial voluntary activities (odds ratio=2.2); (3) a partner's unfavorable attitude toward transplantation (odds ratio=0.3); (4) a favorable attitude toward cadaveric donation (odds ratio=2); and (5) attitude toward living liver donation (odds ratio=3.8). CONCLUSIONS: Attitude toward xenotransplantation is not as favorable among hospital personnel as it is in the general public and this is determined by many factors. It will be necessary for research groups to periodically carry out awareness-raising activities about our findings in our own centers, to avoid the rejection that could be generated by a lack of awareness.

[Primary thymic lymphomas]. / Linfomas primarios del timo.

INTRODUCTION: Primary thymic lymphomas (PTLs) are uncommon, and their prognosis is linked with early treatment. A review is carried out of this disease in our hospital in order to determine the best diagnostic-therapeutic management for these patients. MATERIAL AND METHODS: Ten LPTs--four Hodgkin's and six non-Hodgkin's (4 primary mediastinal B lymphomas [PMBLs] and 2 lymphoblastic T lymphomas [LTLs]--were reviewed. Most of the patients were females, with a mean age of 23 +/- 10 years. RESULTS: The initial diagnostic suspicion in the Hodgkin's lymphomas was thymoma in two cases and lymphoma in the other 2. All of them underwent surgery, including an intra-operative biopsy, which was completed with a thymectomy in the two in which thymoma was reported. They were treated with radio and chemotherapy. The response was partial in two cases, and treatment was completed with a bone marrow transplant (BMT) (one died and the other had active disease). The non-Hodgkin's lymphomas had large tumors and short evolution. All of them received surgery, with an intra-operative biopsy in four and a thymectomy in two. They were treated with chemotherapy, with associated radiotherapy in two. The response was total in three, with two recurring, who are in complete remission after a BMT. In the other three the response was partial. CONCLUSIONS: In a patient with thymic tumour with a preoperative or intraoperative study suspected of having a lymphoma, it is necessary to do a biopsy and not resective surgery, to avoid unnecessary resections and morbidity. PTLs are uncommon but aggressive, principally the non-Hodgkin's lymphomas. The main treatment is radio and chemotherapy, with associated bone marrow transplantation in selected cases.

Linfomas primarios del timo / Primary thymic lymphomas

Introducción. Los linfomas primarios tímicos (LPT) son infrecuentes, pero su pronóstico va ligado a un tratamiento precoz. Se realiza una revisión de esta patología en nuestro hospital con el objetivo de determinar cuál es el mejor manejo diagnóstico-terapéutico en estos pacientes. Material y métodos. Se revisan diez LPT, cuatro Hodgkin y seis no Hodgkin (4 linfomas primarios mediastínicos B [LPMB] y 2 linfomas linfoblásticos T [LLT]). La edad media fue de 23 ± 10 años, siendo la mayoría mujeres. Resultados. En los linfomas de Hodgkin la sospecha diagnóstica inicial fue de timoma en dos casos y de linfoma en los dos restantes. Todos fueron intervenidos, realizándose una biopsia intraoperatoria, completándose con una timectomía en los dos que informó de timoma. Se trataron con radioquimioterapia. En dos casos la respuesta fue parcial, completándose el tratamiento con un trasplante de médula ósea (TMO) (uno fue éxitus, y el otro presentaenfermedad activa). Los linfomas no Hodgkin (LNH) presentaban grandes tumoraciones y una evolución corta. Todos fueron intervenidos, realizándose en cuatro una biopsia y en dos una timectomía. Se trataron con quimioterapia, asociándose en dos radioterapia. La respuesta fue total en tres, recidivando dos, que tras TMO están en remisión completa. En los tres restantes la respuesta fue parcial. Conclusiones. Ante un paciente con tumoración tímica sugestiva por el estudio preoperatorio o intraoperatorio de linfoma debe realizarse una biopsia quirúrgica y no cirugía resectiva para evitar resecciones y morbilidad quirúrgica innecesaria. Los LPT son infrecuentes pero agresivos, sobre todo los LNH, siendo su principal tratamiento la radioquimioterapia, asociada a TMO en casos seleccionados

Introduction. Primary thymic lymphomas (PTLs) are uncommon, and their prognosis is linked with early treatment. A review is carried out of this disease in our hospital in order to determine the best diagnostic-therapeutic management for these patients. Material and methods. Ten LPTs - four Hodgkin's and six non-Hodgkin's (4 primary mediastinal B lymphomas [PMBLs] and 2 lymphoblastic T lymphomas [LTLs] - were reviewed. Most of the patients were females, with a mean age of 23 ± 10 years. Results. The initial diagnostic suspicion in the Hodgkin's lymphomas was thymoma in two cases and lymphoma in the other 2. All of them underwent surgery, including an intra-operative biopsy, which was completed with a thymectomy in the two in which thymoma was reported. They were treated with radio and chemotherapy. The response was partial in two cases, and treatment was completed with a bone marrow transplant (BMT) (one died and the other had active disease). The non-Hodgkin's lymphomas had large tumors and short evolution. All of them received surgery, with an intra-operative biopsy in four and a thymectomy in two. They were treated with chemotherapy, with associated radiotherapy in two. The response was total in three, with two recurring, who are in complete remission after a BMT. In the other three the response was partial. Conclusions. In a patient with thymic tumour with a preoperative or intraoperative study suspected of having a lymphoma, it is necessary to do a biopsy and not resective surgery, to avoid unnecessary resections and morbidity. PTLs are uncommon but aggressive, principally the non-Hodgkin's lymphomas. The main treatment is radio and chemotherapy, with associated bone marrow transplantation in selected cases

Ancillary hospital personnel faced with organ donation and transplantation.

OBJECTIVE: To reduce the number of family organ donation refusals, it is necessary not only to act on the general public but also on the health care system. In this respect, there are data suggesting that the percentage of hospital personnel against donation is high, especially among ancillary personnel. The objective herein was to analyze the attitudes of ancillary hospital professionals toward donation of their own organs and determine factors that conditioned such attitudes. MATERIALS AND METHODS: A random sample in a third-level hospital with a solid organ transplant program was stratified by ancillary services: administrative, porters, maintenance, cleaning, and cooking. Attitudes toward donation of one's own organs after death were evaluated using a questionnaire on psychosocial aspects validated in our area. It included various psychosocial variables that could affect such attitudes. The Student t test and chi-square test were used to evaluate the data. RESULTS: We analyzed 277 respondents of mean age 43 +/- 8 years and 96% women. The level of acceptance of organ donation was 64% (n = 178), whereas 46% were either against or undecided (n = 98). The variables which determined the attitudes were understanding of brain death (P = .004); attitude toward cadaveric manipulation, especially toward autopsy (P = .013) and cremation (P = .004); concern about mutilation after donation (P = .014); religion (P = .032); partner's attitude toward donation (P < .0001); and possibility of needing an organ in the future (P = .031). CONCLUSIONS: Ancillary hospital personnel had similar attitudes toward donation as those of the general public as observed in other studies. The attitudes were determined by many psychosocial factors. A campaign to raise awareness among professionals has become a priority, given that working in a hospital, their unfavorable attitude could have a strong negative impact on the general public.

Attitudes of resident doctors toward different types of organ donation in a Spanish transplant hospital.

OBJECTIVE: Our aim was to analyze acceptance of cadaveric and living organ donation for transplantation among resident doctors, given that they are the new professionals of medicine who will have to encourage and develop transplant programs. MATERIALS AND METHODS: A random survey was performed on resident doctors in a third-level hospital with an organ transplant program which is accredited for undergraduate and postgraduate education (n = 171). Attitudes toward cadaveric and living donation were evaluated using a questionnaire including various psychosocial variables that might affect such attitudes. We used the Student t test and the chi-square test. RESULTS: The sample was composed of responses by 171 resident doctors of mean age 28 +/- 4 years with 56% women. Attitudes toward cadaveric donation were favorable in 92% (n = 157). As for living donation, the percentage in favor of nonrelated donation was low: 23% for kidney and 19% for liver. However, when the donation was from a relative, the percentages increased to levels similar to those of cadaveric donation, namely 88% and 85% for kidney and liver, respectively. No differences were observed in attitudes toward cadaveric or living donation according to various psychosocial variables. CONCLUSIONS: The trainee doctors showed favorable attitudes toward human cadaveric organ donation as well as living related donation, which suggests a relaunch of living donors in the near future. However, there was not much acceptance of nonrelated donation, as has also been seen in studies of the general public in our geographical area.

Ancillary personnel faced with living liver donation in a Spanish hospital with a transplant program.

INTRODUCTION: Ancillary hospital personnel represent an important body of opinion because as they work in a hospital their opinion has more credibility for the general public as a result of their activity in hospitals. However, in most cases they do not have any health care training which means that their attitude could be based on a lack of knowledge or unfounded fears. The objective of this study is to analyze the attitude toward living liver donation among ancillary personnel in a hospital with a cadaveric and living liver organ transplant program and to analyze the variables that might influence such attitude. PATIENTS AND METHOD: A random sample was taken which was stratified by service (n=401) among ancillary personnel in the hospital. Attitude was evaluated using a survey that was validated in our geographical area. A representative from each service was contacted. This person was given an explanation of the study and was made responsible for the distribution of the questionnaire in selected work shifts. The survey was completed anonymously and was self-administered. The c2 test, Student s t-test and logistical regression analysis were used in the statistical analysis. RESULTS: The questionnaire completion rate was 94% (n=377). Of all the respondents, 20% (n=74) are in favor of donating a living hemi-liver, but an additional 62% (n=233) are in favor if donation is for a relative. Of the rest, 8% (n=30) do not accept this type of donation and the remaining 11% (n=40) are unsure. The following variables are related to attitude toward living liver donation: attitude toward cadaveric donation (p=0.002); a respondent s belief that he or she might need a transplant in the future (p<0.001) and a willingness to receive a donated living liver if one were needed (p<0.001). In the multivariate analysis the following have been found to be significantly related variables: a) a respondent s belief that he or she might need a transplant in the future (OR=1.5); and b) a willingness to receive a living donated kidney if one were needed (OR=16.2). CONCLUSIONS: Attitude toward living liver donation is fairly favorable among ancillary personnel in a transplant hospital and is not affected by the psychosocial factors found to be related to attitude toward donation in previous studies. However, if we want to encourage this type of transplantation with living donors it will be necessary to carry out informative campaigns to raise awareness within the hospital.

Attitude toward deceased organ donation and transplantation among the workers in the surgical services in a hospital with a transplant program.

INTRODUCTION: There are data that suggest that the percentage of hospital workers not in favor of donation is relatively high, even in services that are directly related to transplantation. The objective was to analyze attitudes toward decreased organ donation in the surgical services. MATERIALS AND METHODS: A random sample was stratified by the surgical service and the job category (n = 263) in a third-level hospital with a transplant program assessed attitudes toward the donation of ones own organs after death using a questionnaire including psychosocial factors as validated in our geographic surroundings. Student t test and the chi-square test were used for data analysis. RESULTS: Favorable attitudes toward donation were observed in 68% (n = 178) as opposed to 32% with an attitude that was undecided or against the act (n = 85). The psychosocial variables that showed significant relationships with this attitude were age (most in favor are younger; P = .021); nonmedical surgical staff (50% against donation; P = .0001); resident physicians (94% in favor; P = .001); discussion and prior consideration of donation (P = .016); knowledge of the concept of brain death (an important factor in nonhealth staff; P = .010); attitude toward manipulation of the deceased (P = .011) and concerns about mutilation (P = .026); partner's opinion toward organ donation (P = .0001); and existence of frequent medical errors (P = .003). No significant differences were found, depending on whether the services were involved in a specific transplant program (P = .853). CONCLUSIONS: Favorable attitudes toward donation among the hospital staff on surgical services, including those who perform transplants, did not reach more than 70% and was determined by multiple psychosocial factors. Donation promotion activities are necessary for these services, given the importance that this group's negative attitude could have on the attitude of the general population.

Attitude survey of hospital workers in the surgical services toward living kidney donation.

INTRODUCTION: A living donor kidney is currently the most accepted kind of solid organ donation, given the low level of morbidity and mortality and the good results in the recipient. In Spain, its use is still scarce; even many health service workers are not in favor. Our objective was to analyze the attitudes toward living kidney donation in a surgical department. MATERIALS AND METHODS: A random sample was stratified according to surgical services and job category in a tertiary hospital with an solid organ transplant program. Attitudes toward living kidney donation were evaluated using a questionnaire on donation and transplantation, which evaluated various psychosocial variables. Student's t test and the Chi square test were used. RESULTS: Two hundred sixty-three respondents of mean age 40 +/- 10 years were analysed for attitudes toward living kidney donation. The level of acceptance was 87% (n = 229) versus 13% undecided or against the procedure (n = 34). No differences were observed according to job category. The variables that showed a relationship with the attitude were the partner's attitude toward donation (P = .049); the possible need for an organ oneself (P = .0001); and belief that medical errors occur (P = .001). The attitude toward cadaveric organ donation was not reflective of that toward living kidney donation (P = .241). CONCLUSIONS: A favorable attitude toward living kidney donation was high among hospital staff of the surgical department. Those for whom it was not favorable were influenced by personal factors such as partner's attitude and the possibility of needing a kidney in the future.