Análisis de la donación renal efectiva por muerte encefálica en un hospital de nivel 2 de la comunidad de Madrid en un período de 10 años / Analysis of effective renal donation from brain-dead donors in a level II hospital over 10 years

OBJETIVOS: Las características epidemiológicas del donante en muerte encefálica se han modificado a lo largo del tiempo sin un incremento significativo en la tasa de explantes efectuados. Evaluar si las características epidemiológicas (sexo, edad y causa de exitus) del donante en muerte encefálica se han modificado a lo largo del tiempo. Evaluar si la tasa de explantes efectivos se ajustan a un estándar de calidad. MÉTODOS: En este estudio retrospectivo se incluyeron todos los pacientes con donación renal (una o dos unidades renales) en el período comprendido entre el 1 de enero de 1995 y el 31 de diciembre de 2005, en un hospital de Nivel 2 con Unidad de Cuidados Intensivos, pero sin Neurocirugía y sin ser centro de referencia de politraumatismos severos, en un área sanitaria de la Comunidad de Madrid (Móstoles, 200.000 habitantes). Se evaluó la causa de éxitus, la edad, serología para VHB o VHC, así como la donación conjunta de otros órganos (hígado, páncreas, intestino, corazón, pulmón y tejidos). Además se evaluarán las diferencias entre dos periodos de tiempo consecutivos: 1995-1999 y 2000-2005. Para el análisis estadístico se aplicará el Test T para muestras independientes, considerándose como significativo un error alfa inferior a 0.05, median- te el Software SPSS v13.0 (Chicago, Illinois, USA) para Windows. Para el ajuste de la tasa de explantes se utilizará como indicador de calidad un mínimo de un 0,2 % del total de exitus intrahospitalario. RESULTADOS: Durante todo el periodo a estudio hubo 4314 exitus en todo el ámbito hospitalario. Se realizaron 46 extracciones renales con una edad media de 58.1 años (error estándar de la media -eem- de 14.25). En el primer periodo (1995-1999) se produjeron 20 donaciones con una edad media de 52.8 años (eem 12.13) y en el segundo periodo (2000-2005) se produjeron 26 donaciones con una edad media de 62.23 (eem 14.49) años. No obstante no existieron diferencias estadísticamente significativas entre ambos grupos (p=0.273). En total 8 pacientes fueron VHB positivos (17.4 %) y 4 (8.7 %) VHC positivo. En el 80.4 % de los pacientes la causa de muerte encefálica fue una hemorragia cerebral (37 pacientes), el 15.2 % por en- cefalopatía hipóxica (7 pacientes), un paciente falleció por embolia grasa tras accidente de tráfico y otra por púrpura trombótica. No existieron diferencias en cuanto a la causa de exitus entre ambos periodos (p>0.05). Se realizó extracción hepática en el 74 % de los pacientes, cardiaca y pulmonar en el 6,5 %, pancreática en el 4,3 % y de tejido en el 50 %. La tasa de donación fue de un 1,05 %. CONCLUSIONES: 1. Existe una tendencia al alza en la edad del donante en muerte encefálica, aunque sin significación estadística, probablemente debido al tamaño muestral. 2. Las tasas de detección de donantes en muerte encefálica se encuentra por encima de los estándares de calidad. No obstante, se deberían establecer programas formativos a nivel hospitalario para la detección de estos pacientes y mejorar los resultados obtenidos (AU)

OBJECTIVES: The epidemiological characteristics of brain-dead donors have changed with time without a significant increase in the rate of explants performed. The objective of this article is to evaluate if the epidemiological characteristics (sex, age, and death cause) have changed with time, and To evaluate if the rate of effective explants is adjusted to a quality standard. METHODS: All patients who became renal donors (one or two renal units) between January 1st 1995 and December 31st 2005 in a level II hospital with intensive care unit but without neurosurgery, which is not a re- ference center for severe polytrauma patients, within a health-care area of the Autonomic Community of Madrid (Mostoles, 200.000 inhabitants), were included in this retrospective study. Cause of death, age, HBV and HCV serologies, as well as multiorgan donation (liver, pancreas, bowel, heart, lungs, and tissues). Additionally, the differences between two consecutive periods of time will be analyzed: 1995-1999 and 2000-2005. SPSS v 13.0 software (Chicano, Illinois, USA) was used for the statistical analysis; the T test for independent samples was applied, considering an alpha error inferior to 0.05 for significance. A minimum of 0.2% of the total number of hospital deaths was considered as quality indicator for the adjustment of donation rate. RESULTS: Over the whole study period there were 4314 deaths in the hospital. Forty-six renal harvestings were performed with a mean donor age of 58.1 yr. (mean standard error (SE)14.25) . In the first study period (1995-1999) there were 20 donations with a donor mean age of 52.8 yr. (SE 12.13), and there were 26 donations in the second period (2000-2005) with a mean age of 62.23 yr. (SE 14.49) . Nevertheless, the- re were no statistically significant differences between both groups (p = 2.273). A total of eight patients were HBV positive (17.4%) and four (8.7%) HCV positive. In 80.4% of the patients the cause of brain death was brain hemorrhage (37 patients),15.2% hypoxic encephalopathy (7 patients), one patient died due to fat embolism after motor vehicle accident, and another one from thrombotic purpura. There were no differences in death cause between both periods (p> 2.05). Hepatic extraction was performed in 74% of the patients, heart and lung in 6.5%, pancreas in 4.3%, and tissues in 50%. Donation rate was 1.05%. CONCLUSIONS: 1. There is a trend to higher brain- dead-donor age, although it is not statistically significant, probably due to sample size. 2. The rate of brain-dead donor detection is over quality standards. Nevertheless, training programs to detect these patients and improve results should be established at the hospital level (AU)

[Analysis of effective renal donation from brain-dead donors in a level II hospital over 10 years]. / Análisis de la donación renal efectiva por muerte encefálica en un Hospital de Nivel 2 de la Comunidad de Madrid en un periodo de 10 años.

OBJECTIVES: The epidemiological characteristics of brain-dead donors have changed with time without a significant increase in the rate of explants performed. The objective of this article is to evaluate if the epidemiological characteristics (sex, age, and death cause) have changed with time, and To evaluate if the rate of effective explants is adjusted to a quality standard. METHODS: All patients who became renal donors (one or two renal units) between January 1st 1995 and December 31st 2005 in a level II hospital with intensive care unit but without neurosurgery, which is not a reference center for severe polytrauma patients, within a health-care area of the Autonomic Community of Madrid (Mostoles, 200.000 inhabitants), were included in this retrospective study. Cause of death, age, HBV and HCV serologies, as well as multiorgan donation (liver, pancreas, bowel, heart, lungs, and tissues). Additionally, the differences between two consecutive periods of time will be analyzed: 1995-1999 and 2000-2005. SPSS v 13.0 software (Chicano, Illinois, USA) was used for the statistical analysis; the T test for independent samples was applied, considering an alpha error inferior to 0.05 for significance. A minimum of 0.2% of the total number of hospital deaths was considered as quality indicator for the adjustment of donation rate. RESULTS: Over the whole study period there were 4314 deaths in the hospital. Forty-six renal harvestings were performed with a mean donor age of 58.1 yr. (mean standard error (SE)14.25). In the first study period (1995-1999) there were 20 donations with a donor mean age of 52.8 yr. (SE 12.13), and there were 26 donations in the second period (2000-2005) with a mean age of 62.23 yr. (SE 14.49). Nevertheless, there were no statistically significant differences between both groups (p = 2.273). A total of eight patients were HBV positive (17.4%) and four (8.7%) HCV positive. In 80.4% of the patients the cause of brain death was brain hemorrhage (37 patients), 15.2% hypoxic encephalopathy (7 patients), one patient died due to fat embolism after motor vehicle accident, and another one from thrombotic purpura. There were no differences in death cause between both periods (p> 2.05). Hepatic extraction was performed in 74% of the patients, heart and lung in 6.5%, pancreas in 4.3%, and tissues in 50%. Donation rate was 7.05%. CONCLUSIONS: 1. There is a trend to higher brain-dead-donor age, although it is not statistically significant, probably due to sample size. 2. The rate of brain-dead donor detection is over quality standards. Nevertheless, training programs to detect these patients and improve results should be established at the hospital level.

[Upper urinary tract tumor: differential diagnosis by radiological images]. / Tumor de urotelio superior: diagnóstico diferencial por imágen radiológica.

To perform the adequate treatment of upper urinary tract lesions it is very important to have an exact diagnosis. When the suspicion of an upper tract urothelial tumor is established the initial evaluation is carried out by imaging diagnostic tests (intravenous urography, pyelography, and others). The association of radiological tests and urine cytologies allows us to get to a correct diagnosis in most cases. Upper urinary tract endoscopy solves some equivocal cases, but sometimes it is impossible to clarify the nature of the lesion in spite of a comprehensive diagnostic effort. Therapeutic decision should be individualized in these cases. The objective of this article is to describe the various features of upper tract urothelial tumors in a variety of available imaging tests, and to review all conditions that may have similar images, describing the characteristic radiological findings for each of them. We discuss about differential diagnosis and perform a critical evaluation of the diagnostic difficulties that occasionally present upper urinary tract diseases.

Tumor de urotelio superior diagnóstico diferencial por imágen radiológica / Upper urinary tract tumor: differential diagnosis by radiological images

La obtención de un diagnóstico exacto de las lesiones del tracto urinario superior es de gran importancia para llevar a cabo un tratamiento adecuado. La evaluación inicial ante la sospecha de un tumor de urotelio superior se realiza mediante técnicas de diagnóstico por imagen (urografía intravenosa, ecografía, tomografía axial computerizada, pielografía y otras). La asociación de estos estudios radiológicos con las citologías de orina permite llegar a un diagnóstico correcto en la mayoría de los casos. La endoscopia del tracto urinario superior permite resolver algunos casos equívocos pero ocasionalmente no es posible aclarar la naturaleza de la lesión a pesar de un esfuerzo diagnóstico exhaustivo. En estos casos es imprescindible individualizar la decisión terapéutica. El objetivo de este trabajo es describir los diferentes aspectos del tumor de urotelio superior en las diversas pruebas de imagen disponibles para su estudio radiológico y revisar todos aquellos procesos que pueden adoptar imágenes similares al tumor de urotelio superior, realizando una descripción de los hallazgos radiológicos característicos de cada uno de ellos. Se discute sobre los distintos aspectos del diagnóstico diferencial y se realiza una evaluación crítica de las dificultades diagnósticas que ocasionalmente se presentan en la patología del tracto urinario superior (AU)