Procura de órganos: no hay trasplantes sin donantes / Organ procurement: there are not transplantations without donors

No hay trasplantes de órganos y no hay órganos si no hay donantes. Esta es la conclusión fundamental tras analizar la experiencia en la procura de órganos para transplante, llevada a cabo por un médico especificamente destinado a esta función, en el Hospital Dr, Gustavo Fricke de Viña del Mar, entre el 1 de Enero de 1997 y el 30 de Junio de 1998. Con una casuística de 44 casos de donantes potenciales, se analizan los conceptos utilizados en la procura, estableciendo sus etapas, las patologías que permiten su iniciación y las contraindicaciones para ser donante, además de sus características de ocurrencia, horario, lugar dentro del Hospital y causales de pérdida de la donación. La falta de motivación y participación de los equipos médicos que laboran en los servicios en los que se producen los potenciales donantes, reafirma la necesidad de mejor información y coordinación, actividad que es mucho más productiva cuando es llevada a cabo por un médico especializado en la procura de órganos

Conversión de sandimmune a neoral en pacientes trasplantados renales que reciben ciclosporina-ketoconazol / Conversion of sandimmune to neoral in patients with renal transplantation treated with cyclosporine-ketoconazol

Patients and methods: Thirty four patients with more than one year after the transplantation, with stable renal function and receiving triple immunosuppression were studied. Conventional cyclosporine was changed to the microemulsion form maintaining the same daily dose. Drug serum levels, serum creatinine and blood pressure were measured within two to eight months after the conversion. Doses of microemulsion cyclosporine were adjusted to achieve serum levels of 150 ñ 40 ng/ml. Results: Microemulsion cyclosporine induced a slight initial increase in blood cyclosporine levels. Afterwards, levels were more stable than with conventional cyclosporine (165-185 and 145-210 ng/ml respectively) and the dispersion of values were lower (standard deviations of 70 and 100 ng/ml respectively). Twenty three patients did not require dose adjustments, in four it was reduced and in five it was increased. There were no changes in serum creatinine or blood pressure after the conversion. Conslusion: More stable serum levels without adverse reactions were obtained with microemulsion cyclosporine. Doses of cyclos porine need not to be changed during the conversion

Insuficiencia renal aguda en pacientes con y sin sepsis: pronóstico y evolución / Acute renal failure in septic and non septic patients: prognostic and evolution

The purpose of this prospective study was to determine whether the course and prognosis of acute renal failure (ARF) in patients with and without sepsis are different. 252 (8 percent) of 3086 consecutive patients admited to a medical surgical intensive care unit (ICU) developed ARE. One hundred forty-nine (59 percent) were septic and 103 (41 percent) were non-septic. No differences were founded between groups regarding the incidence of oliguria, hyperkalemia, hypercatabolism, gastrointestinal bleeding, duration of oliguria and renal deficit, severity of azotemia, dialysis requirements and duration of stay in the hospital. There were statistically significant differences between septic and non septic patients with respect to hyponatremia (67.8 vs 54.4 percent, p<0.04), respiratory failure (68 vs 54 percent, p<0.04), and thrombocytopenia (64 vs 48 percent, p<0.02). Mortality in septic patients was higher than in non-septics (56 vs 42.7 percent, p<0.009). Factors associated with increased mortality in ARF septic patients were respiratory failure, metabolic acidosis and oliguria while in the non-septics they were hepatic dysfunction, hyperkalemia, respiratory failure and infection acquired during the course of renal failure. We conclude that ARF developing in septic patients has a higher mortality than that of non-septic patients, whereas the incidence of hypercatabolism and oliguria was not different between both groups

Evaluación de gravedad en 1000 pacientes críticos / Evaluation of seriousness in 1.000 critical patients

Evaluamos 1000 pacientes críticos según la escala de gravedad APS-2 (2) descrita por William Knaus (desde 1988 a 1991) con elo objeto de conocer su capacidad para estimar la mortalidad en nuestro medio. La mortalidad global fue de un 28 por ciento en esta serie, superior a las series extranjeras de comparación, utilizadas (5,6). Se analizan los factores que explican estas diferencias, y se evaluó la utilización de el APS-2, como herramienta en la selección de las admisiones a la Unidad de Cuidados Intensivos (UCI)