El donante multitejido: una opción a nuestro alcance / Multi-tissue donor: a reachable option

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)

[Multi-tissue donor: a reachable option]. / El donante multitejido: una opción a nuestro alcance.

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.

Cor pulmonale hipertensión pulmonar secundaria a síndrome crest. Tratamiento con ultrafiltración lenta continua / Cor pulmonale-PHT secondary to crest syndrome. Treatment with slow continuous ultrafiltration

La hipertensión pulmonar es una patología grave con un tratamiento complejo basado en medidas generales, anticoagulación y utilización de fármacos específicos vasodilatadores. La insuficiencia cardiaca derecha instaurada en estadios finales de la enfermedad se trata con diuréticos. Presentamos la ultrafiltración lenta continua como tratamiento en insuficiencia cardiaca derecha secundaria a hipertensión pulmonar asociada a enfermedad del colágeno refractaria a tratamiento diurético (AU)

Pulmonary hypertension is a severe disease with complex treatment based on general measurements, anticoagulation and use of specific vasodilator drugs. Right heart failure initiated in final stages of the disease is treated with diuretics. We present the case of slow continuous ultrafilitration as treatment in right heart failure secondary to pulmonary hypertension associated to collagen disease refractory to diuretic treatment (AU)

[Cor pulmonale-PHT secondary to crest syndrome. Treatment with slow continuous ultrafiltration]. / Cor pulmonale hipertensión pulmonar secundaria a síndrome crest. Tratamiento con ultrafiltración lenta continua.

Pulmonary hypertension is a severe disease with complex treatment based on general measurements, anticoagulation and use of specific vasodilator drugs. Right heart failure initiated in final stages of the disease is treated with diuretics. We present the case of slow continuous ultrafilitration as treatment in right heart failure secondary to pulmonary hypertension associated to collagen disease refractory to diuretic treatment.

Utilidad de la plasmaféresis en cuidados intensivos / Utility of plasmapheresis in intensive care

Presentamos las plasmaféresis (PMF) realizadas en una unidad de cuidados intensivos (UCI) polivalente de 18 camas en el quinquenio comprendido entre los años 2003-2007. El objetivo del presente artículo es comunicar nuestra experiencia en PMF realizada con monitores específicos para tratamientos continuos de reemplazo renal (TCRR) y evidenciar la versatilidad derivada del uso de estos tratamientos y de estos monitores en las UCI. La utilidad de estos procedimientos abarcan muchos escenarios de la enfermedad crítica ingresada en nuestras unidades (pacientes neurológicos, hematológicos, reumatológicos). En definitiva, nuestra experiencia en PMF nos lleva a concluir que es un tratamiento de depuración extracorpórea sencillo, que puede realizar el personal sanitario de cuidados intensivos en cualquier momento dentro de un amplio espectro de indicaciones clínicas, con monitores de TCRR y con unas complicaciones asociadas a la técnica mínimas y leves (AU)

We discuss the plasmapheresis (PE) carried out in an 18-bed polyvalent intensive care unit between the years 2003-2007. This article aims to report our experience in plasmapheresis performed with specific monitors for continuous renal replacement therapy (CRRT) that shows the versatility of the use of these procedures in intensive care. The utility of these procedures include many different critical disease settings in our units (neurology, hematology, and rheumatology patients). In short, our experience in PE has led us to the conclusion that plasmapheresis is a simple extracorporeal depuration treatment that can be performed by staff trained in intensive care at any moment within a wide spectrum of clinical indications, with CRRT monitors and with minimum adverse effects (AU)

[Utility of plasmapheresis in intensive care]. / Utilidad de la plasmaféresis en cuidados intensivos.

We discuss the plasmapheresis (PE) carried out in an 18-bed polyvalent intensive care unit between the years 2003-2007. This article aims to report our experience in plasmapheresis performed with specific monitors for continuous renal replacement therapy (CRRT) that shows the versatility of the use of these procedures in intensive care. The utility of these procedures include many different critical disease settings in our units (neurology, hematology, and rheumatology patients). In short, our experience in PE has led us to the conclusion that plasmapheresis is a simple extracorporeal depuration treatment that can be performed by staff trained in intensive care at any moment within a wide spectrum of clinical indications, with CRRT monitors and with minimum adverse effects.

[Indications and long-term outcomes for solid organ transplant. Quality of life in solid organ transplant recipients]. / Indicaciones y resultados a largo plazo de los trasplantes de órganos sólidos. Calidad de vida en pacientes trasplantados.

Organ transplant constitutes one of the most encouraging advances in the history of the medicine. The organ transplants that were a distant challenge in the seventies currently are a routine procedure in the medical practice that has contributed to extending survival and quality of life in the general population. Spain has reached the highest rate for donation and transplants per one million inhabitants worldwide, this extraordinary health care work being a combined achievement of Spanish Health Care System. The objective of this article is to review the indications of solid organ transplants and their long-term outcomes, evaluating the impact on the health-related quality of life in solid organ transplant recipients.

Indicaciones y resultados a largo plazo de los trasplantes de órganos sólidos. Calidad de vida en pacientes trasplantados / Indications and log-term outcomes for solid organ transplant. Quality of life in solid organ transplant recipients

El trasplante de órganos constituye uno de los avances más espectaculares en la Historia de la Medicina. Los trasplantes de órganos, que todavía eran un reto lejano en la década de los setenta del siglo pasado, constituyen actualmente un procedimiento rutinario de la práctica médica que ha contribuido a prolongar la supervivencia y la calidad de vida de la población.España ha alcanzado la tasa más elevada del mundo en donación y trasplantes por millón de habitantes, siendo esta extraordinaria tarea asistencial un logro del sistema sanitario español en su conjunto.El objetivo de esta revisión es repasar las indicacionesde los trasplantes de órganos sólidos en la actualidad y sus resultados a largo plazo, evaluando el impacto sobre la calidad de vida relacionada con la salud de los pacientes receptores de un trasplante de órgano sólido

Organ transplant constitutes one of the mostencouraging advances in the history of the medicine.The organ transplants that were a distant challenge in the seventies currently are a routine procedure in the medical practice that has contributed to extending survival and quality of life in the general population.Spain has reached the highest rate for donationand transplants per one million inhabitants worldwide,this extraordinary health care work being a combined achievement of Spanish Health Care System.The objective of this article is to review the indications of solid organ transplants and theirlong-term outcomes, evaluating the impact on thehealth-related quality of life in solid organ transplant recipients (AU)

[Smoking prevention intervention among secondary school students in the Spanish province of Malaga]. / Intervención sobre tabaquismo en estudiantes de enseñanza secundaria de la provincia de Málaga.

OBJECTIVE: To assess the prevalence of smoking among 13- to 18-year-old students, analyze smoking-related factors in this population, and design an intervention program to reduce smoking. POPULATION AND METHODS: A 6-month smoking prevention intervention was designed for students at a public secondary school in the Spanish province of Malaga. The objective of the intervention was to inform students of the gravity of smoking and its deleterious effects on health. The efficacy of the intervention was subsequently assessed. RESULTS: Of the 337 students who completed the questionnaire, 27% declared they were smokers. Smoking prevalence was significantly higher among girls (36.1%) than boys (18.1%) (P<.001) and progressively increased with age. Initiation occurred at 13 to 14 years of age. The most common reason for starting was to try something new (52.2% of students). The greatest risk factor in the family environment was having a smoking sibling. After the program, 78% of smokers admitted that the intervention had not affected their smoking but had made them more aware of its detrimental effects, and 66.8% planned to quit in the future. CONCLUSIONS: The study shows the high prevalence of smoking among adolescents, particularly among girls. It also shows that health education increases understanding of the problems related to smoking, causing changes of attitude with regard to whether they will smoke in the future.

Intervención sobre tabaquismo en estudiantes de enseñanza secundaria de la provincia de Málaga / Smoking prevention intervention among secondary school students in the Spanish province of Malaga

Objetivo: Conocer el consumo de tabaco en jóvenes de entre 13 y 18 años, analizar los factores asociados con el tabaquismo en esta población y desarrollar un programa de intervención para reducir su consumo. Población y métodos: Se ha diseñado un programa de intervención sobre tabaquismo de 6 meses de duración, dirigido a estudiantes de Enseñanza Secundaria Obligatoria de un instituto de la provincia de Málaga, orientado a informarles sobre la magnitud del problema del tabaquismo y sus efectos patológicos. Posteriormente se ha evaluado la eficacia de dicha intervención. Resultados: De los 337 alumnos que cumplimentaron la encuesta, el 27% se declaraba fumador. El consumo era significativamente (p < 0,001) mayor en las mujeres (36,1%) que en los varones (18,1%) y se incrementaba de forma progresiva con la edad. La edad de comienzo se situaba entre los 13 y 14 años. El motivo más frecuente por el que iniciaban al consumo era probar algo nuevo (un 52,2% de los alumnos). En el entorno familiar el mayor factor de riesgo para el adolescente era tener un hermano fumador. Una vez finalizado el programa, aunque el 78% reconocía que éste no había influido directamente sobre su consumo, tenía más conciencia de los efectos perjudiciales del tabaco y el 66,8% de los fumadores se planteaba dejarlo en el futuro. Conclusiones: El estudio pone de manifiesto el elevado consumo de tabaco en los adolescentes, fundamentalmente en las chicas. Además, demuestra que la educación sanitaria es útil para mejorar el conocimiento sobre el problema del tabaquismo, ya que provoca un cambio de actitud en los adolescentes fumadores respecto a su futuro consumo

Objective: To assess the prevalence of smoking among 13- to 18-year-old students, analyze smoking-related factors in this population, and design an intervention program to reduce smoking. Population and Methods: A 6-month smoking prevention intervention was designed for students at a public secondary school in the Spanish province of Malaga. The objective of the intervention was to inform students of the gravity of smoking and its deleterious effects on health. The efficacy of the intervention was subsequently assessed. Results: Of the 337 students who completed the questionnaire, 27% declared they were smokers. Smoking prevalence was significantly higher among girls (36.1%) than boys (18.1%) (P<.001) and progressively increased with age. Initiation occurred at 13 to 14 years of age. The most common reason for starting was to try something new (52.2% of students). The greatest risk factor in the family environment was having a smoking sibling. After the program, 78% of smokers admitted that the intervention had not affected their smoking but had made them more aware of its detrimental effects, and 66.8% planned to quit in the future. Conclusions: The study shows the high prevalence of smoking among adolescents, particularly among girls. It also shows that health education increases understanding of the problems related to smoking, causing changes of attitude with regard to whether they will smoke in the future

[Lung scintigraphy with technetium 99m depreotide in the assessment of solitary pulmonary nodules]. / La gammagrafía con 99mTc-depreótida en la valoración del nódulo pulmonar solitario.

A solitary pulmonary nodule (SPN) is defined as a parenchymal lesion measuring less than 3 cm in diameter that is not associated with other lesions. Ninety percent of SPNs are discovered incidentally and most are benign. The management of radiographically indeterminate SPNs has not been established and invasive procedures must be undertaken in order to understand the nature of the nodule. We review our experience with the use of somatostatin receptor scintigraphy with technetium Tc99m depreotide in 10 patients with suspected malignant SPN. We discuss the limitations and applications of this technique in the evaluation of whether SPNs are benign or malignant for the purpose of identifying patients for biopsy. For this application, this technique can be considered an alternative to positron emission tomography using fluorine-18 fluordeoxyglucose.

Hallazgo de un timoma en un estudio tomográfico de perfusión miocárdica con 99mTc-Tetrofosmina / Finding a thymoma in a 99mTc-Tetrofosmin myocardial perfusion imaging

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