Magnetic resonance cholangiography in the diagnosis of biliary complications after orthotopic liver transplantation.

OBJECTIVE: The aim of our study was to evaluate the role of magnetic resonance cholangiography (MRC) in the diagnosis of biliary tract complications (BC) after orthotopic liver transplantation (OLT). MATERIALS AND METHODS: Among 21 OLT patients who underwent routine follow-up MRC using a breath-hold T2-weighted turbo spin-echo sequence with half-Fourier acquisition (HASTE), 5 had an elevated serum alkaline phosphatase level. Diagnostic confirmation was obtained with endoscopic retrograde cholangiography (ERC) (n = 11), surgery (n = 3), or clinical and laboratory follow-up of at least 1 year (n = 8). RESULTS: In 13 patients, no abnormality of the biliary tract was detected using MRC. In 8 patients, anastomotic strictures were diagnosed, 7 of which were confirmed at surgery or using ERC. One patient with normal findings at MRC and abnormal liver function test results was found to have a stricture at ERC. All patients with normal MRC and liver function tests had 1 year of uneventful follow-up and were considered true-negative cases. We found that MRC had 87.5% sensitivity, 92.3% specificity, 87.5% positive predictive value, 92.3% negative predictive value, and 90.4% accuracy for the diagnosis of BC. CONCLUSION: MRC is a valuable examination to detect BC after OLT. It provides useful information for planning interventional procedures.

Simultaneous pancreas-kidney transplantation: infectious complications and microbiological aspects.

OBJECTIVE: The purpose of this study was to describe the clinical and microbiological characteristics of the infectious complications among simultaneous pancreas-kidney transplantations (SPKT). MATERIALS AND METHODS: Among the first 45 SPKT the mean age was 34 years (range, 21 to 49) and the mean duration of follow-up 13 months (range, 2 to 27 months). RESULTS: Twenty-three patients (51%) presented at least one to three episodes (1.7 mean) of infectious complications that needed hospitalization. The etiology of the infections included 71% bacterial (44% gram-negative rods and 27% gram-positive cocci), 16% viral (12% from CMV and 4% from Herpes sp) and 13% fungal (8% by Candida sp and 4% by others fungus). Wound and urinary infections were most frequent, occurring in 22% and 28% of the patients, respectively. All patients who were submitted to vesical drainage developed infections in contrast a rate of only 44% among patients undergoing enteric drainage. CONCLUSION: Infectious complications are the main cause of morbidity and mortality following simultaneous pancreas-kidney transplantation, especially with vesical drainage. The use of enteric drainage combined with administration of broad spectrum prophylactic antibiotics is recommended.

Evaluación de los conocimientos sobre la prevención de accidentes biológicos en la enfermería de atención primaria / Evaluation of knowledge of prevention of accidents with biological risk in the primary care infirmary

Objetivo: Conocer el nivel de información y formación frente al accidente biológico y el estado vacunal respecto a la hepatitis B en atención primaria. Material y métodos: Se realizó un estudio transversal mediante encuesta. La población de estudio fue el personal de enfermería de atención primaria de la ciudad de Barcelona que pertenece a la red reformada del Institut Català de la Salut. Constituyó la muestra el personal de siete áreas básicas. Se utilizó un cuestionario de 20 preguntas específicamente elaborado para este estudio. Se realizó un análisis proporcional de las diferentes variables. Resultados: Contestaron al cuestionario el 74,2 por ciento del personal seleccionado. El riesgo de seroconversión para los virus de la inmunodeficiencia humana (VIH), la hepatitis B y la hepatitis C fue, en general, poco conocido por el personal encuestado. El 8,3 por ciento no conocía las medidas de protección estándar, el 13,9 por ciento no utilizaba correctamente los guantes y hasta un 61,1 por ciento encapuchaba las agujas contaminadas después de usarlas. El accidente biológico más frecuente era el pinchazo (77,8 por ciento). La notificación del accidente biológico era del 66,7 por ciento. La mayoría del personal (84,7 por ciento) requería más formación e información. El 70,8 por ciento estaba vacunado contra la hepatitis B. Conclusiones: Existe un bajo conocimiento por parte del personal de enfermería de atención primaria del riesgo de transmisión de infecciones virales por vía parenteral y el nivel de vacunación contra el VHB es bajo. Es necesario diseñar estrategias de prevención en la atención primaria (AU)