Extension of right renal vein in renal transplant from deceased donors: cohort study.

OBJECTIVES: Throughout the world, 45 000 kidney transplants are performed per year. Graft and overall survival vary according to the type of donor (living or deceased donor). Anastomosis of a short renal vein with iliac vein or common external iliac vein has been associated with technical problems such as angulation of the vein or tension on the anastomosis, which could limit visualization and control of bleeding from the graft. The main objective of our study was to analyze patients undergoing deceased-donor kidney transplant and compare results in patients who had extension of the right renal vein with a patch of vena cava from the same donor versus patients who received the left kidney. MATERIALS AND METHODS: A prospective cohort study was performed from December 31, 2007 to December 31, 2009. We compared 2 patients groups. We used statistical software (R, Version 2.5.1). The analyzing team was blinded to the surgical technique, and informed consent was obtained from all patients. RESULTS: There was no statistically significant difference in surgical time (P > .85) or ultrasonographic parameters between groups, but it was possible to perform an easier vein anastomosis with the vena cava graft in right kidney transplant. CONCLUSIONS: We recommend considering our procedure with the vena cava graft in right kidney as an alternative option to decrease warm ischemia time, perform an easier vein anastomosis with the vena cava extension, and make the procedure comfortable for the surgeon.

[Renal transplantation in Maastricht II asystole: report of a first case in Mexico]. / Trasplante renal en asistolia Maastrich II. Reporte del primer caso en México.

On May 6, 2012, an 18-year-old patient was admitted to the emergency room with sever traumatic brain injury and cardiovascular arrest; resuscitation maneuvers were started with a compressor table AUTOPULSE®. After 30 minutes, death was pronounced. Later, compressions were restarted. After the family agreed with the donation, blood samples were obtained to do serology tests and to obtain blood group and Rh factor and a cardiopulmonary bypass was started by femoral approach. After 2 hours and 35 minutes, extraction of the kidneys was performed. This case represented the first organ procurement from a non-heart-beating Maastricht II donor in our country. After 60 days, both receptors remained free of dialysis.

Hypocalcaemia as a prognostic factor of early mortality in moderate and severe traumatic brain injury.

OBJECTIVES: Our main objective was to evaluate whether serum hypocalcaemia on the third day [defined as < 2.1 mmol/l (8.5 mg/dl)] is a prognostic factor for early mortality after moderate and severe traumatic brain injury (TBI). METHODS: We developed an ambispective comparative case control study. We evaluated clinical profiles from included patients from January 2005 to July 2009 and we prospectively recruited additional patients from August 2009 to July 2011. Patients were between 1 and 89 years old and had a Glasgow Coma Scale of 3-12 points following TBI. RESULTS: We calculated an Odds Ratio of 5.2 (Confidence Intervals 95%: 4.48 to 6.032) for hypocalcaemia on day three, which was associated with death. Retrospectively (January 2005 to July 2009) we compiled data from 81 patients. Prospectively (August 2009 to July 2011) we recruited 41 patients. The adjusted variables in the logistic regression final model were: serum calcium on day three (Odds Ratio 3.5, Confidence Intervals 95%: 1·12 to 13·61, P < 0·028) and anisocoria (Odds Ratio 8·24, Confidence Intervals 95%: 1·3 to 67·35, P < 0·019) obtaining an adjusted R2 of 0·22 (P < 0·005). DISCUSSION: The serum levels of calcium on day three could be useful for the prediction of mortality in patients with moderate and severe TBI.

[Evaluation of changes in the treatment of spontaneous intracerebral haemorrhage in a regional hospital in Mexico]. / Evaluacion de cambios en el tratamiento de la hemorragia intracerebral espontanea en un hospital regional mexicano.

INTRODUCTION: The spontaneous intracerebral hemorrhage (ICH) shows a high lethal rate. In 1999 appeared the first therapeutic guidelines, after that new therapies have been assessed without substantial success. AIM: To describe treatment changes for ICH in a regional Mexican hospital and to assess their impact on clinical evolution. PATIENTS AND METHODS: We accomplished a retrospective study of patients admitted between 2000 and 2006. We included those elder than 15 years with tomographyc diagnostic of ICH. Patients with head injury four weeks before or undetermined initial National Institute of Health Stroke Scale (NIHSS) were excluded. Epidemiological, clinical characteristics and kind of therapy were studied. RESULTS: We analyzed 175 patients with mean age of 62 years. Etiology and localization more frequently were arterial hypertension and lobar, respectively. More than 20% were intubated and approximately one half of these admitted in intensive care unit. Angiotensin converter enzyme inhibitors were the medicaments more usually used for controlling blood pressure. An initial NIHSS > 15 or Glasgow < 9 were associated to poor outcome. Additional administration of calcium antagonist, statins and surgical decompression was associated to a better outcome. CONCLUSIONS: Use of intensive care units is a measure highly suggested as standard for ICH-therapy. In our center it was not regularly accomplished because of infrastructural deficiencies. This problem could be generated in other Mexican hospitals; attention to that phenomenon is urgently required. Evaluation of new therapeutic strategies is required.

Evaluación de cambios en el tratamiento de la hemorragia intracerebral espontánea en un hospital regional mexicano / Evaluation of changes in the treatment of spontaneous intracerebral haemorrhage in a regional hospital

Introducción. La hemorragia intracerebral espontánea (HIC) es una entidad neurológica con una elevada tasa de mortalidad. Desde la aparición de las primeras guías de manejo en 1999, se han probado nuevas terapias sin éxito sustancial. Objetivo. Describir los cambios en el tratamiento de la HIC de un hospital regional mexicano y evaluar su posible impacto en la evolución clínica. Pacientes y métodos. Es un estudio retrospectivo entre 2000 y 2006 con pacientes mayores de 15 años y diagnóstico tomográficamente confirmado de HIC. Excluimos pacientes con trauma craneoencefálico en las cuatro semanas previas o puntuación inicial de la National Institute of Health Stroke Scale (NIHSS) indeterminada. Se estudiaron características epidemiológicas, clínicas y tipo de tratamiento. Resultados. Analizamos 175 pacientes con edad promedio de 62 años. La etiología y localización más frecuente fueron hipertensión arterial y lobar, respectivamente. Más del 20% requirió intubación al ingreso y sólo la mitad fue admitida en la unidad de terapia intensiva. NIHSS > 15 o Glasgow < 9 iniciales se asociaron con pobre resultado. Los inhibidores de la enzima conversora de angiotensina se usaron más frecuentemente para el control de la tensión arterial. El uso de antagonistas del calcio, estatinas y descompresión quirúrgica se asoció con un mejor resultado funcional. Conclusiones. El uso de salas de terapia intensiva es una medida fuertemente sugerida como eje del manejo de la HIC. En nuestro centro, esto no se realizó regularmente por un déficit infraestructural. Este problema podría generarse en otros hospitales mexicanos. La revisión de este fenómeno urge. Se requiere la evaluación de nuevas medidas terapéuticas (AU)

Introduction. The spontaneous intracerebral hemorrhage (ICH) shows a high lethal rate. In 1999 appeared the first therapeutic guidelines, after that new therapies have been assessed without substantial success. Aim. To describe treatment changes for ICH in a regional Mexican hospital and to assess their impact on clinical evolution. Patients and methods. We accomplished a retrospective study of patients admitted between 2000 and 2006. We included those elder than 15 years with tomographyc diagnostic of ICH. Patients with head injury four weeks before or undetermined initial National Institute of Health Stroke Scale (NIHSS) were excluded. Epidemiological, clinical characteristics and kind of therapy were studied. Results. We analyzed 175 patients with mean age of 62 years. Etiology and localization more frequently were arterial hypertension and lobar, respectively. More than 20% were intubated and approximately one half of these admitted in intensive care unit. Angiotensin converter enzyme inhibitors were the medicaments more usually used for controlling blood pressure. An initial NIHSS > 15 or Glasgow < 9 were associated to poor outcome. Additional administration of calcium antagonist, statins and surgical decompression was associated to a better outcome. Conclusions. Use of intensive care units is a measure highly suggested as standard for ICH-therapy. In our center it was not regularly accomplished because of infrastructural deficiencies. This problem could be generated in other Mexican hospitals; attention to that phenomenon is urgently required. Evaluation of new therapeutic strategies is required (AU)