The effect of two anionic membranes (AMI 7001s and Neosepta AMX) on the electrodeposition of manganese from sulphate solutions.

The effect of two different anionic membranes on manganese deposition was studied in a two-compartment electrochemical reactor with a titanium cathode and a dimensionally stable RuO2|Ti anode. Chronopotentiometry, ICP-OES, SEM, XRD and elemental mapping were used to understand the changes in concentration and characteristics of the metallic deposition at different current densities with the anionic membranes AMI 7001s and Neosepta AMX. The results demonstrate that AMI reduces more manganese than AMX below -100 A m-2, generating more metallic deposition but also more low-solubility manganous by-products, whereas both membranes exhibited similar behaviours above -100 A m-2 reaching the maximum current efficiency (63%) at -200 A m-2. It was also observed that the membranes have a significant effect on sulphate consumption since they are anions.

Selenium and sulphur reactions involved in manganese reduction from sulphate solutions.

Electrochemical reduction of ionic species during manganese deposition from sulphated aqueous solutions has been studied in an electrochemical reactor with two anionic exchange membranes. Thermodynamic analysis, voltammetries, and chronopotentiometries were used to determine the reaction mechanism of the reductions developed, with the results demonstrating that the effect of the elemental selenium on the hydrogen evolution leads to the formation of elemental sulphur by reducing the sulphate ions with both membranes. It was also evident that in the range of -25 to -50 A m-2 the electrodeposition of metallic manganese begins, with minimal interference from parasitic reactions.

Histological findings in experimentally infected male calves with chronic besnoitiosis.

The histological findings associated to Besnoitia besnoiti infection were exhaustively studied in target tissues from experimentally and chronically infected calves. Calves were inoculated with 106 bradyzoites via intravenous, subcutaneous and intradermal route. Visible pathognomonic sclera cysts were observed in all infected animals. Tissue cysts were more abundant and lesions were more frequent in calves inoculated via intradermal. The most parasitized tissues were skin, including scrotum (40.81% of positive samples), nostril and nasal turbinate. Tissue cysts were already fully developed as the average tissue cyst diameter was 181.20 µm. Microscopic lesions were mainly detected in skin samples, followed by reproductive and upper respiratory tracts. Mild lesions compatible with both acute (thrombus, oedema and inflammation) and chronic besnoitiosis (skin lesions, hyperkeratosis and dilated sweat glands) coexisted. Vascular damage and inflammation were more frequently observed in skin (including scrotum) followed by testicular parenchyma, epididymis and pampiniform plexus. Histological findings evidenced a subclinical chronic besnoitiosis.

The route of Besnoitia besnoiti tachyzoites inoculation does not influence the clinical outcome of the infection in calves.

In a previous attempt, an experimental model of bovine besnoitiosis was established in calves that were intravenously inoculated with different doses of Besnoitia besnoiti tachyzoites. Despite the fact that all infected calves developed the acute stage of disease, only microscopic findings characteristic of chronic besnoitiosis were reported. In the present study, calves were inoculated by subcutaneous and intradermal routes with B. besnoiti tachyzoites with the aim of developing clinical signs and macroscopic lesions characteristic of chronic besnoitiosis. Nine 3-month-old male calves were randomly distributed into three groups of three animals each. Next, 106 tachyzoites were inoculated by either the subcutaneous (G1) or intradermal route (G2). The negative control group (G3) was inoculated with PBS. Daily clinical monitoring and regular blood collection were performed. At 70 days post-infection (pi), animals were euthanized, and tissues were collected to investigate lesions and parasites. Infected animals developed mild-moderate acute besnoitiosis characterized by lymphadenopathy from four days to 47 days pi, and sporadic fever peaks were only observed in one calf from G2. However, other clinical signs and macroscopic lesions characteristic of chronic besnoitiosis were not detected. Only nine tissue samples were B. besnoiti-DNA-positive, eight of which belonged to reproductive and respiratory tracts tissues from G1. Finally, the kinetics of the immune responses were similar in both infected groups. However, delayed and lower cellular and humoral immune responses were observed in G1 followed by G2 and were compared with intravenously inoculated calves. The differences observed among the three inoculation routes could be due to different effector mechanisms of the host early innate immune response against B. besnoiti. Accordingly, the inoculation route of B. besnoiti tachyzoites does not significantly influence the clinical outcome of the infection in calves. Thus, a further refinement of this experimental model of bovine besnoitiosis is needed to reproduce macroscopic lesions characteristic of chronic stage disease.

Bovine chronic besnoitiosis in a calf: Characterization of a novel B. besnoiti isolate from an unusual case report.

Bovine besnoitiosis, caused by the apicomplexan Besnoitia besnoiti, is a chronic and debilitating disease characterized by cutaneous and systemic manifestations that primarily affects adult beef cattle. Previous studies have reported that clinical besnoitiosisis is rare in calves. However, we isolated B. besnoiti from a chronically infected calf for the first time. The identity of the Besnoitia species was determined after parasite isolation and molecular genotyping. According to the results obtained in vitro the new isolate, named as Bb-Spain3, was characterized in a reproducible in vitro model and was categorized as a low invader and low prolific isolate with a slower lytic cycle compared to Bb-Spain 1 isolate. Specific traits that differentiate isolates obtained from adult animals from those infecting calves were not found. Next, we described the first case report of chronic besnoitiosis in a female calf less than 6 months-old with a low body condition. The disease was confirmed by the presence of specific anti-B. besnoiti antibodies and parasite detection in the skin. At post-mortem examination, tissue samples were collected for histological, immunohistochemical and molecular analyses. DNA-parasite was detected in 31 different calf's tissues, being the most highly parasitized tissues the skin and the respiratory and reproductive tracts. In addition, the parasite was also present in heart, eyes, lymph nodes and brain. The high parasite load, a wide intra-organic parasite distribution and the presence of both viable and degenerated cysts, were indicative of a rapid progression of the disease. This case report underlines the need to include the inspection of young animals in besnoitiosis control.

Venous-to-arterial carbon dioxide difference in the resuscitation of patients with severe sepsis and septic shock: A systematic review. / La diferencia venoarterial de dióxido de carbono en la reanimación de pacientes con sepsis grave y shock séptico: una revisión sistemática.

INTRODUCTION: The way to assess tissue perfusion during the resuscitation of patients with severe sepsis and septic shock is a current subject of research and debate. Venous oxygen saturation and lactate concentration have been the most frequently used criteria, though they involve known limitations. The venous-to-arterial difference of carbon dioxide (pCO2 delta) is a parameter than can be used to indicate tissue perfusion, and its determination therefore may be useful in these patients. METHODS: A qualitative systematic review of the literature was made, comprising studies that assessed pCO2 delta in adult patients with severe sepsis or septic shock, and published between January 1966 and November 2016 in the Medline-PubMed, Embase-Elsevier, Cochrane Library, and LILACS databases. There was no language restriction. The PRISMA statement was followed, and methodological quality was evaluated. RESULTS: Twelve articles were included, all of an observational nature, and including 10 prospective studies (9 published since 2010). Five documented greater mortality among patients with high pCO2 delta values, in 3 cases even when achieving venous oxygen saturation targets. In 4 studies, a high pCO2 delta was related to lower venous oxygen saturation and higher lactate levels, and another 3 documented lesser percentage lactate reductions. CONCLUSION: The parameter pCO2 delta has been more frequently assessed in the management of patients with severe sepsis during the last few years. The studies demonstrate its correlation to mortality and other clinical outcomes, defining pCO2 delta as a useful tool in the management of these patients.

La diferencia venoarterial de dióxido de carbono en la reanimación de pacientes con sepsis grave y shock séptico: una revisión sistemática / The venoarterial difference of carbon dioxide in the resuscitation of patients with severe sepsis and septic shock: a systematic review

Introducción La forma de evaluar la perfusión tisular durante la reanimación de pacientes con sepsis grave y shock séptico es tema de estudio y debate en la actualidad. La saturación venosa de oxígeno y el lactato han sido los criterios más utilizados; sin embargo, presentan limitaciones reconocidas. La diferencia venoarterial de dióxido de carbono (delta de pCO2) es una variable que puede indicar el estado de perfusión tisular, por lo que su evaluación puede ser útil en estos pacientes. Métodos Revisión sistemática cualitativa de la literatura que incluyó estudios que evaluaron el delta de pCO2 en pacientes adultos con sepsis grave o shock séptico, publicados entre enero de 1966 y noviembre de 2016 en las bases de datos Medline-PubMed, Embase-Elsevier, Cochrane Library y LILACS. No tuvo restricción de idiomas. Se siguió la declaración PRISMA y se evaluó la calidad metodológica. Resultados Doce estudios fueron incluidos, todos observacionales, 10 prospectivos, 9 publicados a partir del 2010. Cinco documentaron una mayor mortalidad entre pacientes con delta de pCO2 alto, en 3 incluso cuando conseguían metas de saturación venosa de oxígeno. En 4 estudios, un delta de pCO2 alto se relacionó con una menor saturación venosa de oxígeno y niveles mayores de lactato, y otros 3 documentaron un menor porcentaje de disminución de lactato. Conclusión El delta de pCO2 ha sido evaluado en el manejo de los pacientes con sepsis grave y shock séptico con mayor frecuencia en los últimos años. Los estudios demuestran su relación con la mortalidad y otros desenlaces clínicos, de tal forma que puede ser una herramienta útil en el manejo de estos pacientes.

Ejercicio, bienestar psicológico, calidad de sueño y motivación situacional en estudiantes de educación física / Exercise, psychological well-being, sleep quality and situational motivation in physical education students / Exercício, bem-estar psicológico, a qualidade do sono e motivação situacional em estudantes de educação física

El objetivo de este trabajo ha sido comprobar si la exposición a diferentes intensidades de actividad física aguda ocasionaba cambios en el bienestar psicológico (vitalidad subjetiva y estado afectivo), la calidad del sueño y la motivación intrínseca situacional en estudiantes adolescentes en clases de educación física. Para ello, 120 estudiantes (50 chicos y 70 chicas) con edades comprendidas entre los 16 y 20 años completaron, antes y después de pasar por cada situación experimental, medidas de estas variables. Los resultados mostraron, en primer lugar, que había asociaciones directas entre la vitalidad subjetiva, el estado afectivo positivo y la calidad del sueño. En segundo lugar, se encontró un incremento significativo en la motivación intrínseca situacional y disminución en el estado afectivo negativo post-sesión al comparar las intensidades vigorosa y ligera. La mayoría de las dimensiones del bienestar psicológico mejoraban cuando se comparaban las situaciones pre intervención y post intervención, independientemente de la intensidad del ejercicio. Contrariamente a nuestras hipótesis, la calidad del sueño no mejoró al practicar actividad física. La principal conclusión es que la realización de actividad física aguda, independientemente de la intensidad del mismo, mejora el bienestar. Respecto a la motivación, la actividad física vigorosa es la que provoca mayores cambios motivacionales, debiendo tener este aspecto en cuenta a la hora de diseñar programas de actividad física para adolescentes (AU)

The aim of this study was to determine how the exposure to different intensities of acute physical activity, caused changes in psychological well-being (subjective vitality and affective state), sleep quality and situational intrinsic motivation in adolescent students on physical education classes. 120 students (50 boys and 70 girls) aged between 16 and 20 years, completed different questionnaires to measure these variables. The results showed direct and positive associations between subjective vitality, positive affect state and the quality of sleep and significant differences, increasing situational intrinsic motivation and decreasing post-session negative affect when comparing light and vigorous intensities. Almost all dimensions of psychological well-being improved when comparing the preintervention and post intervention situations, regardless of physical activity intensity. Contrary to our hypothesis, sleep quality did not improve by practice of physical activity. The main conclusion is that the acute exercise, regardless of intensity, improves well-being and that vigorous physical activity is causing major motivational changes, must take this into account when designing physical activity programs for adolescents (AU)

O objectivo deste trabalho consistiu em comprovar se a exposição a diferentes intensidades de exercício agudo ocasionava alterações no bem-estar psicológico (vitalidade subjectiva e estado afectivo), na qualidade de sono e na motivação intrínseca situacional de estudantes adolescentes em aulas de educação física. Para tal, 120 estudantes (50 rapazes e 70 raparigas) com idades compreendidas entre os 16 e os 20 anos preencheram, antes e depois de passarem por cada situação experimental, instrumentos de medida destas variáveis. Os resultados mostraram, em primeiro lugar, que havia associações directas entre a vitalidade subjectiva, o estado afectivo positivo e a qualidade de sono. Em segundo lugar, verificou-se um incremento significativo na motivação intrínseca situacional e uma diminuição do estado afectivo negativo após a sessão, ao comparar as intensidades vigorosa e ligeira. A maioria das dimensões do bem-estar psicológico melhorou quando comparadas as situações pré-intervenção e pós-intervenção, independentemente da intensidade do exercício. Contrariamente às nossas hipóteses, a qualidade de sono não melhorou ao praticar actividade física. A principal conclusão é a de a realização de exercício agudo, independentemente da sua intensidade, melhora o bem-estar. Relativamente à motivação, a actividade física vigorosa é a que provoca maiores alterações motivacionais, devendo ter-se este aspecto em consideração quando forem desenhados programas de actividade física para adolescentes (AU)

High-risk hepatoblastoma: results in a pediatric liver transplantation center.

AIM: Aim of the study was assess the results of the treatment of High-Risk Hepatoblastoma (HRH) in a tertiary center where all liver surgery facilities, including pediatric transplantation (LT), are available. METHODS: 91 primary liver tumors treated between 1991 and 2009 were retrospectively reviewed. HRHs as defined by the SIOP criteria (PRETEXT IV or any stage with venous involvement, extrahepatic disease, tumor rupture and <100 ng/ml serum AFP) were identified and imaging and biopsies were reviewed. The treatment consisted of total removal of the tumor, involving extended hepatectomies and LT if necessary, together with SIOPEL-guided chemotherapy. RESULTS: 23/57 hepatoblastomas were HRH (11F/12M). 17 were considered unresectable by standard techniques, 3 had extrahepatic disease, and 3 fulfilled both criteria. Mean age at diagnosis was 2.3 ± 2.4 years. 3 children (referred after chemotherapy) died without surgery. 4 had resections (2 left and 2 right trisegmentectomies). Primary LT was required in 15 children (7 cadaveric donors and 8 living related donor transplantations (LRDT), 2 of them with retrohepatic vena cava replacement), and 1 patient had rescue LT after recurrence. Mean follow-up was 4.8 ± 2.9 years. 2 children who had undergone liver resection developed pulmonary metastases at 1.7 and 1.6 years postoperatively and survived after surgical treatment. 2 children with LT developed EBV-related lymphoma and leukemia respectively but survived. Event-free survival (EFS) at 1, 5, and 10 years was 78.3 ± 8.6%, 63.1 ± 10.5%, and 63.1 ± 10.5%, respectively. 6 children died (3 without surgery, 1 after liver resection, 1 after primary LT and 1 after rescue LT). Overall survival at 1, 5 and 10 years was 78.3 ± 21.7%, 73.2 ± 26.8% and 73.2 ± 26.8%. Of those with primary LT, survival at 1, 5 and 10 years was 93.3 ± 6.4%, 93.3 ± 6.4% and 93.3 ± 6.4%. CONCLUSIONS: Outstanding results in the treatment of HRH are possible in tertiary centers when referral is early (preferably at diagnosis) and specialized liver surgery and transplantation facilities are available.

Necesidad de la bipartición hepática o split en el trasplante en niños / Need of hepatic bipartition or split in the transplant in children

Objetivo. Analizar el beneficio del trasplante hepático (TH) con labipartición adulto-niño. Pacientes /métodos. 1) Análisis de la mortalidad pretrasplante calculadas sobre 228 inclusiones a TH (enero 2004-diciembre 2008).2) Impacto de las técnicas alternativas (donante vivo/bipartición) en la mortalidad pretrasplante de nuestros enfermos. 3) Análisis de los resultados de 33 biparticiones que dieron lugar a 66 trasplantes (1994-2008). Resultados. Referida por 1.000 enfermos y año de exposición, la mortalidad pretrasplante fue de 110 en niños mayores de 5 años, 180en niños de 2 a 5 años, 90 en niños entre 1 y 2 años, y 510 en menores de 1 año (p<0,05 respecto a restantes grupos). 36/66 injertos divididos fueron implantados por nuestro grupo. Cinco se perdieron, 3 por retrasplante, 2 por fallecimiento. La supervivencia actuarial a 10 años fue94,5% (enfermos) y 85,1% (injerto). Los 30 injertos restantes fueron trasplantados en otros hospitales, de los que 4 se perdieron precozmente. En el (..) (AU)

Aim. To analyze the benefits of Split (for adult and for child) in liver transplantation. Patient/methods. 1) Analysis of the waiting list mortality estimated on 228 inclusions for transplant since January 2004 to December2008. 2) Impact of the variant techniques (living-related donor and split)on the waiting list mortality in our patients. 3) Analysis of the outcome of 33 split livers which allowed to perform 66 transplants (1994-2008). Results. Estimated as number of patients by 1,000 candidates by year of exposure, the waiting list mortality was 110 in children older than5 year old, 180 in children from 2 to 5 year-old, 90 in children between1 and 2 year-old and 510 in younger than 1 year (p<0.05 for the last group). 36/66 split grafts were implanted by our group. Five grafts were (..) (AU)

Trasplante intestinal: ¿en qué fase estamos? / Intestinal transplant: in what phase are we?

Objetivo. Analizar la evolución del trasplante intestinal (TI) desde el inicio del programa .Material y métodos. Estudiamos retrospectivamente todos los niños con TI (1997-2009): epidemiología, situación previa, técnica quirúrgica, inmunosupresión, resultados, supervivencia y calidad de vida .Resultados. Realizamos 52 TI (20 intestinal aislado, 20 hepatointestinal, 12 multiviscerales) en 46 niños, edad mediana 32m (rango7m-19a); peso 12,3 kg (rango 3,9-60); 31 tenían intestino corto, 8 dismotilidad, 5 diarrea intratable y 2 misceláneos. Veintiséis se intentaronadaptar inicialmente, 20 se incluyeron directamente como candidatos. La modalidad de trasplante se modificó durante su espera en 18. Todos recibieron tacrolimus y corticoides requiriendo 5 conversión a sirolimus posteriormente. Seis fallecieron el primer mes por sepsis/fallo multiorgánico (mala situación basal); 13 fallecieron tardíamente; observamos rechazo agudo en 20, rechazo crónico en 3, síndrome linfoproliferativo en 8 (fallecieron 6), y EICH en 5 (fallecieron 3). La supervivencia tras 5 años es del 65,2 % (51,7% el injerto). Desde 2006-2008,la supervivencia a los 6m, 1 y 3 años del paciente/injerto es 88,7/84,1,81,2/81,2 y 81,2/71,1%, respectivamente. Tras un seguimiento medio de 39 ± 29 meses, todos los pacientes vivos (n=27, 59%) son autónomos digestivos (70% ya sin estoma), están escolarizados, con mínimosingresos y buena calidad de vida. Conclusiones. El TI se afianza como alternativa de tratamiento en (..) (AU)

Objective. To analyze the evolution of Small Bowel Transplantation program since the beginning of the program. Matherial and methods. All children who underwent intestinal transplantation between 1997 and 2009 were retrospectively reviewed: epidemiological data, status before transplant, surgical technique, immunosupression, results, survival and long. term quality of life were analysed. Results. Fifty-two intestinal transplants were performed in 46 children (20 isolated bowel, 20 combined liver and intestine, and 12 multivisceral); median age was 32m (range 7m-19a); weight 12,3 kg (range3,9-60); 31 had short gut syndrome, 8 dismotility, 5 intractable diarrhea, and two were miscellaneous. Intestinal adaptation was initially attempted in 26 patients, without success, 20 were directly listed for transplant. The modality of transplant was modified in 17 while listed. Baseline immune supression consisted of tacrolimus and steroids, although 5 required conversion to Sirolimus later. Six died during the first month, due to sepsis/multiorganic failure (poor status at transplant);13 died during the long-term follow-up. Acute rejection was seen in 20,chronic rejection in 3, PTLD in 8 (6 died) and GVHD in 5 patients (3died). Overall survival after 5 years of follow-up is 65,2 % (51,7% for (..) (AU)

[Intestinal transplant: in what phase are we?]. / Trasplante intestinal: ¿en qué fase estamos?

OBJECTIVE: To analyze the evolution of Small Bowel Transplantation program since the beginning of the program. MATERIAL AND METHODS: [corrected] All children who underwent intestinal transplantation between 1997 and 2009 were retrospectively reviewed: epidemiological data, status before transplant, surgical technique, immunosupression, results, survival and long.term quality of life were analysed. RESULTS: Fifty-two intestinal transplants were performed in 46 children (20 isolated bowel, 20 combined liver and intestine, and 12 multivisceral); median age was 32m (range 7m-19a); weight 12,3 kg (range 3,9-60); 31 had short gut syndrome, 8 dismotility, 5 intractable diarrhea, and two were miscellaneous. Intestinal adaptation was initially attempted in 26 patients, without success, 20 were directly listed for transplant. The modality of transplant was modified in 17 while listed. Baseline immunosupression consisted of tacrolimus and steroids, although 5 required conversion to Sirolimus later. Six died during the first month, due to sepsis/multiorganic failure (poor status at transplant); 13 died during the long-term follow-up. Acute rejection was seen in 20, chronic rejection in 3, PTLD in 8 (6 died) and GVHD in 5 patients (3 died). Overall survival after 5 years of follow-up is 65,2 % (51,7% for the graft). From 2006 to 2008, overall patient/graft survival at 6 m, 1 and 3 years after transplant is 88,7/84,1, 81,2/81,2 and 81,2/71,1%, respectively. After a median follw-up of 39 +/- 29 months, 27 patients are alive (59%), off TPN, (70% had their ostomy taken down), go to school, are scarcely hospitalized and enjoy a good quality of life. CONCLUSIONS: Intestinal transplantation has consolided itself as a good choice for irreversible intestinal failure, being feasible to achieve a normal life. Although overall survival diminishes over time, the center experience has improved the results. These patients need a very close follow-up, once transplant is over, in order to get an early diagnose of immunological complications.

[Need of hepatic bipartition or split in the transplant in children]. / Necesidad de la bipartición hepática o split en el trasplante en niños.

AIM: To analyze the benefits of Split (for adult and for child) in liver transplantation. PATIENT/METHODS: 1) Analysis of the waiting list mortality estimated on 228 inclusions for transplant since January 2004 to December 2008.2) Impact of the variant techniques (living-related donor and split) on the waiting list mortality in our patients. 3) Analysis of the outcome of 33 split livers which allowed to perform 66 transplants (1994-2008). RESULTS: Estimated as number of patients by 1,000 candidates by year of exposure, the waiting list mortality was 110 in children older than 5 year old, 180 in children from 2 to 5 year-old, 90 in children between 1 and 2 year-old and 510 in younger than 1 year (p<0.05 for the last group). 36/66 split grafts were implanted by our group. Five grafts were lost, 3 due to retransplantation and 2 due to death. Overall patient/graft survival alter 10 years of follow-up was 94.5% and 85.1%, respectively. The rest of the grafts (n=30), were used in other hospitals, and 4 were lost in the early postoperative period. Since the beginning of the study, 85.4% of children between 1 and 2 years, received a living-donor or a split graft, as only 59.9% in the younger than 1 year-old group. CONCLUSION: Our results absolutely justify the ethics of split liver transplantation for an adult and a child. Despite other factors, the benefits of the variant techniques in the 1-2 year-old group are obvious. Up to 60% optimization with these techniques in children younger than 1 year would not be yet enough in order to decrease the mortality waiting list down to that of the rest of the groups.

[Liver transplant from living donor]. / Trasplante hepático de donante vivo.

AIM: Even though Spain has the highest donation rate in the world, our needs cannot be satisfied, specially in younger children. Living-related donor transplant is an alternative in those cases. PATIENTS AND METHOD: We performed a retrospective study of 57 living-related donor transplants performed in our hospital between June 1993 and December 2007. Median age and weight were 1.2 years old (0.5-14.8) and 8.5 kg (5-62). Indications for transplant were as follow: biliary atresia in 42 cases (73.7%), hepatic tumor in 8 (14%) and others in 7 patients. Type of graft was: monosegment (n=1), left lateral segment (n=45), extended left lateral segment (n=5), left liver (n=4), right liver (n=2). We studied the following factors: graft and patient survival (Kaplan Meier), perioperative conditions, complications, causes of graft lost, donor complications and technique difficulties. RESULTS: Patient survival at 3 months, 1 year, 5 years and 10 years was 98.2%, 98.2%, 95% and 95% respectively. Three grafts werelost due to arterial thrombosis, two due to rejection, one due to portal thrombosis and three due to other causes. Complications were as follow: biliary fistula in the cut surface (6), biliary anastomosis complications (6), cut surface abcess (1), portal stenosis (2), suprahepatic stenosis (1) and intestinal perforation (2). Most common complication in donors was biliary leak (4). Among the technique difficulties, 8 patients needed major reconstruction of suprahepatic vein; 4 needed complex portal reconstruction, 6 patients had double biliary tract and 4 patients needed multiple arterial anastomosis. Wall closure was delayed (Goretex) in 35% of cases (20). CONCLUSIONS: Despite technical complications, results after living-related donor transplantation are excellent. It is particularly favourable for children with low weight, since Spanish policy for organ allocation does not make easy to find an adecuate donor in short periods of time. Without living-related donor transplantations, mortality pretransplant would be much higher.

[Liver bipartition as an alternative to the transplant]. / Bipartición hepática como alternativa en el trasplante.

AIM: Liver pediatric transplantation finds in the lack of donors its main limitation. An alternative in those cases is split liver grafts from bigger donors. PATIENTS AND METHOD: We performed a retrospective study of 56 hepatic split transplants performed between 1994 and 2007. Twenty-nine children were transplanted with a median age and weight of 1.8 years old (0.3-9) and 9.7 kg (6.2-23). In 16 cases (53.3%) liver transplant was performed in emergency situation. In one patient we performed a combined transplant (liver-kidney) and in another patient it was a second transplant due to primary graft failure after receiving an hepatointestinal allograft. Type of grafts used were: lateral left segment (n=26), extended lateral left segment (n=1) and extended right liver (n=3). Median donor age and weight were 20 years old (8-44) and 60 kg (24-80). We studied patient and graft survival (Kaplan Meier), perioperative factors, complications and net rate of early complications in adults recipients. RESULTS: Patient survival was 96.7% after 6 months, 1 year, 5 years and 10 years. Id for grafs 86.7%. Two grafts were lost due to arterial thrombosis, one due to primary non function and another due to recipient death secondary to a sepsis. Five children had major biliary complications and 2 of them developed multiple intrahepatic stenoses, one of them being on waiting list for retransplant. Early graft lost (retransplant or death before leaving the hospital) occurred in 4 out of the 25 grafts transplanted in other centers (25 adults, 1 kid); all of them occurred in the initial period (1994-2001). CONCLUSIONS: Even though it is clearly documented that benefit of transplant (measured in years of life won) is very good after split transplantation, nowadays criteria for organ allocation in Spain do not allow a more extensive diffusion of this technique and it is confined to urgent transplant. Even in those cases, results after split transplantation are excellent. Without this possibility our pretransplant mortality would be much higher.

Epidemiologic study of community-acquired pneumonia treated at a tertiary-care hospital: Does Fine’s pneumonia severity index influence decision-making in the emergency department?

Objectives: To determine the incidence of community-acquired pneumonia and describe its characteristics. To assess differences influenced by Fine’s pneumonia severity index. Methods: Prospective, descriptive study of patients with community-acquired pneumonia treated over a period of1 year in the emergency department of Hospital General Universitario in Alicante, Spain. Social, demographic and clinical variables (including laboratory, radiologic, and microbiologic data) were collected. Destination on discharge from the emergency department and patient status at 30 days were recorded. The pneumonia severity index was determined according to Fine’s prediction rule, and patients were then classified as being at low (< III) or high (> III) risk. Differences between the 2 risk classes and the distribution of admissions according to risk were analyzed. Results: Five hundred fifty patients with community-acquired pneumonia were included. The cumulative incidence was2.2 cases per 1000 patient-years. Patients with community-acquired pneumonia at high risk had more comorbidity and functional decline, a higher incidence of respiratory failure, and infiltrates in multiple lobes. An etiologic diagnosis was established for 209 patients (38%). The most common microorganism isolated was Streptococcus pneumoniae in all risk classes. The admission rate was 77.2% (high-risk classes, 99.5%; low-risk, 65.1%). The patients were admitted to the respiratory medicine department, the short-stay unit, and the internal medicine department. Risk class influenced patient destination on discharge from the emergency department (AU)

Objetivo: Conocer la incidencia y características clínicas de los pacientes con neumonía adquirida en la comunidad (NAC) y reflejar las diferencias en función de la gravedad determinada por el índice de Fine (IF).Método: Estudio descriptivo y prospectivo de los pacientes con NAC atendidos en el servicio urgencias (SU) del Hospital General Universitario de Alicante durante un año. Se recogieron variables sociodemográficas, clínicas, analíticas, radiológicas, microbiológicas y relacionadas con el destino al alta. Se realizó seguimiento a los 30 días. Se determinó la gravedad de la NAC según el IF, y se clasificó en NAC de bajo riesgo (..) (AU)

Trasplante hepático de donante vivo / Liver transplant from living donor

Objetivo. Pese a la elevada tasa de donaciones en España, las necesidades de trasplante hepático, especialmente en niños de bajo peso, no están cubiertas. Una alternativa en estos casos es recurrir a los donantes vivos. Pacientes y método. Análisis retrospectivo de los 57 trasplantes hepático con injerto de donante vivo (THDV), realizados en nuestro hospital entre junio de 1993 y diciembre de 2007. La mediana de edad y peso fue de 1,2 años (0,5 – 14,8) y 8,5 Kg (5 – 62) respectivamente. Las indicaciones de trasplante fueron atresia biliar en 42 casos (73,7%),tumor hepático irresecable en 8 (14,0%) y otras en 7 pacientes. El tipo de injerto fue: monosegmento (n=1); segmento lateral izquierdo (n =45), segmento lateral izquierdo extendido (n = 5), hígado izquierdo(n=4), hígado derecho (n = 2). Las variables analizadas fueron: supervivencia del enfermo y del injerto (Kaplan Meier), variables (..) (AU)

Aim. Even though Spain has the highest donation rate in the world, our needs cannot be satisfied, specially in younger children. Living related donor transplant is an alternative in those cases. Patients and method: We performed a retrospective study of 57living-related donor transplants performed in our hospital between June1993 and December 2007. Median age and weight were 1.2 years old(0.5-14.8) and 8.5 kg (5-62). Indications for transplant were as follow: biliary atresia in 42 cases (73.7%), hepatic tumor in 8 (14%) and others in 7 patients. Type of graft was: monosegment (n=1), left lateral segment (n=45), extended left lateral segment (n=5), left liver (n=4),right liver (n=2). We studied the following factors: graft and patient survival (Kaplan Meier), perioperative conditions, complications, causes of graft lost, donor complications and technique difficulties. Results. Patient survival at 3 months, 1 year, 5 years and 10 years was 98.2%, 98.2%, 95% and 95% respectively. Three grafts were lost due (..) (AU)

Bipartición hepática como alternativa en el trasplante / Liver bipartition as an alternative to the transplant

Objetivo. El trasplante hepático pediátrico, encuentra en la falta de donantes su principal limitación. Una alternativa en estos casos es recurrir a la bipartición (split) de hígados procedentes de donantes de mayor peso. Pacientes y método. Análisis retrospectivo de 56 trasplantes hepáticos con injerto procedente de bipartición entre 1994-2007. Fueron implantados a 29 niños con una mediana de edad y peso de 1,8 años (0,3-9,0) y 9,7 Kg (6,2-23). En 16 casos (53,3%) el TH fue realizado en situación de emergencia. En un caso el trasplante fue combinado (hígado riñón) y en otro se trataba de un retrasplante por fallo primario del injerto hepático tras haber recibido un aloinjerto hepatointestinal. El tipo de injerto fue: segmento lateral izquierdo (n = 26), segmento lateral izquierdo extendido (n = 1), hígado derecho extendido (n = 3). La mediana de (..) (AU)

Aim. Liver pediatric transplantation finds in the lack of donors its main limitation. An alternative in those cases is split liver grafts from bigger donors. Patients and method. We performed a retrospective study of 56hepatic split transplants performed between 1994 and 2007. Twenty-nine children were transplanted with a median age and weight of 1.8 years old (0.3-9) and 9.7 kg (6.2-23). In 16 cases (53.3%) liver transplant was performed in emergency situation. In one patient we performed a combined transplant (liver-kidney) and in another patient it was a second transplant due to primary graft failure after receiving an hepatointestinal allograft. Type of grafts used were: lateral left segment (n=26), extended lateral left segment (n=1) and extended right liver (n=3). Median donor (..) (AU)

Clinical response to ertapenem in severe community-acquired pneumonia: a retrospective series in an elderly population.

To evaluate in routine hospital practice the clinical response to ertapenem in comparison with other parenteral antibiotics in the treatment of community-acquired pneumonia (CAP), clinical records from patients with severe CAP treated with ertapenem from July 2002 to June 2006 in seven Spanish hospitals were retrospectively reviewed. Patients were classified according to the Pneumonia Severity Index (PSI). Each ertapenem-treated patient was matched with two patients in the same hospital treated with other antibiotics, according to age (difference 76 years). Comorbidities were present in 193 patients (95.5%). No differences were found in median hospital stay (7 days for ertapenem vs. 10 days for comparators, p 0.066). A slightly higher clinical response rate was obtained for ertapenem vs. comparators (88.7% vs. 77.1%; p 0.0465; OR 2.25; 95% CI 0.99-5.12), with significant differences in clinical response in patients coming from nursing homes (95.8% ertapenem vs. 63.8% comparators; p 0.0034) but not in non-institutionalized patients (85.4% ertapenem vs. 84.5% comparators; p 0.929). The higher clinical response to ertapenem vs. comparators in severe CAP was due to its significantly higher efficacy in healthcare-associated CAP in patients coming from nursing homes.