Development of a non-heart-beating donor program and results after the first year.

Our lung transplant unit began activity in October 2008. We have performed 37 lung transplants with a hospital mortality of 2.7% (n = 1). The need for a greater number of donors and the presence of an already existent non-heart-beating donor (NHBD) program for abdominal grafts and tissues encouraged us to consider assessing lung grafts from these donors. It was necessary to develop a new multiorgan preservation methodology, "bithermia preservation." The clinical experience with which during the first year June 2010 to July 2011, including 15 NHBDs is presented herein. The chest x-ray was normal in 6 donors (40%) and 7 had pulmonary infiltrates. Bronchoscopy was normal in 8 donors (53%) but 3 had abundant bleeding airway secretions and signs of bronchoaspiration. Preservation procedures were performed in 6 donors. Pulmonary functional evaluation in 4 donors showed gas measurements to be adequate in 75% of cases. Three double-lung grafts were judged to be valid for implantation, among which we performed 3 lung transplantations, 1 bilateral and 2 unilaterals, while 2 grafts were offered to the National Transplant Organization for other units. No transplant suffered primary graft dysfunction; all 3 showed excellent function allowing early extubation in 2 cases. There was no in-hospital mortality. All 3 patients are alive and leading normal lives; none has bronchiolitis obliterans syndrome. In conclusion, the "bithermia preservation" methodology achieved adequate lung preservation in NHBDs, allowing liver, kidneys, and lungs to be obtained from the same donor.

[Comparative study of burnout in Intensive Care and Emergency Care nursing staff]. / Estudio comparativo del burnout en personal de enfermería de Cuidados Intensivos y Urgencias.

OBJECTIVE: To assess and compare the burnout level between Intensive Care Unit and Emergency Unit, and study its association with the sociodemographic and work characteristics of the professionals surveyed. DESCRIPTION: Cross-sectional, descriptive study. Emplacement. Intensive Care Unit of the university hospital Morales Meseguer, Murcia-Spain. STUDIED SAMPLE: 97 nursing professionals: 55 professionals belong to the Emergency Department, and 42 professionals belong to the Intensive Care Department. METHOD: Two evaluation tools were used: a sociodemographic and work survey, and the Maslach Burnout Inventory, 1986. Quantitative variables expressed as mean +/- SD compared with the Student's T test and qualitative variables compared with the chi2 test. STATISTICAL ANALYSIS: SPSS 12.0(c). RESULTS: The comparative analysis of the burnout dimensions shows that emotional exhaustion level is significantly higher in the intensive care service than in the emergency one (25.45 +/- 11.15 vs 22.09 +/- 10.99) p < 0.05. The rest of burnout dimensions do not show significant differences between both departments. The masculine gender obtains a higher score in the depersonalization dimension of burnout (10.12 +/- 5.38) than female one (6.7 +/- 5.21) p < 0.01. There is greater vulnerability to emotional exhaustion among the professional group with more than 15 years of work experience (F = 3.592; p = 0.031). CONCLUSIONS: The burnout levels are moderate to high among the nursing professionals studied. A total of 5.15% of the sample studied achieves a high score in the three dimensions of the burnout syndrome. The intensive care professionals are the most vulnerable to suffering high levels of emotional exhaustion, and the masculine gender is more susceptible to depersonalization attitudes.

Estudio comparativo del burnout en personal de enfermería de Cuidados Intensivos y Urgencias / Comparative study of burnout in Intensive Care and Emergency Care nursing staff

Objetivo. Estimar y comparar el nivel de burnout existente en los Servicios de Cuidados Intensivos y Urgencias, y estudiar su asociación con las características sociodemográficas y laborales de los profesionales encuestados. Diseño. Estudio descriptivo transversal. Emplazamiento. Servicios de Urgencias y Cuidados Intensivos del Hospital Morales Meseguer (Murcia). Muestra. Noventa y siete profesionales de enfermería, 55 pertenecientes al Servicio de Urgencias y 42 al Servicio de Cuidados Intensivos. Método. Se emplearon dos instrumentos de evaluación: una encuesta de variables sociodemográficas y laborales, y el cuestionario Maslach Burnout Inventory, de 1986. Las variables cuantitativas se expresan como media ± desviación estándar comparadas con t de Student y las cualitativas se comparan con Chi2. El análisis de datos se realizó mediante el programa informático SPSS 12.0(C). Resultados. El análisis comparativo de las dimensiones que componen el burnout demuestra que los niveles de agotamiento emocional son significativamente mayores en el Servicio de Cuidados Intensivos que en el de Urgencias (25,45 ± 11,15 frente a 22,09 ± 10,99) p < 0,05. El resto de dimensiones que componen el síndrome no ha demostrado diferencias significativas entre ambos servicios. El género masculino obtiene una mayor puntuación en la dimensión de despersonalización (10,12 ± 5,38) que el género femenino (6,7 ± 5,21) p < 0,01. Existe una mayor vulnerabilidad al agotamiento emocional en el grupo de profesionales que llevan más de 15 años trabajando (F = 3,592; p = 0,031). Conclusiones. Los niveles encontrados de burnout resultaron ser moderados-altos. El 5,15% de la muestra total estudiada puntúa alto en las tres dimensiones del síndrome, los profesionales de Cuidados Intensivos son los más vulnerables a padecer elevados niveles de agotamiento emocional y el género masculino es el más propenso a las actitudes de despersonalización

Objective. To assess and compare the burnout level between Intensive Care Unit and Emergency Unit, and study its association with the sociodemographic and work characteristics of the professionals surveyed. Description. Cross-sectional, descriptive study. Emplacement. Intensive Care Unit of the university hospital Morales Meseguer, Murcia-Spain. Studied sample. 97 nursing professionals: 55 professionals belong to the Emergency Department, and 42 professionals belong to the Intensive Care Department. Method. Two evaluation tools were used: a sociodemographic and work survey, and the Maslach Burnout Inventory, 1986. Quantitative variables expressed as mean ± SD compared with the Student's T test and qualitative variables compared with the chi2 test. Statistical analysis: SPSS 12.0(C). Results. The comparative analysis of the burnout dimensions shows that emotional exhaustion level is significantly higher in the intensive care service than in the emergency one (25.45 ± 11.15 vs 22.09 ± 10.99) p < 0.05. The rest of burnout dimensions do not show significant differences between both departments. The masculine gender obtains a higher score in the depersonalization dimension of burnout (10.12 ± 5.38) than female one (6.7 ± 5.21) p < 0.01. There is greater vulnerability to emotional exhaustion among the professional group with more than 15 years of work experience (F = 3.592; p = 0.031). Conclusions. The burnout levels are moderate to high among the nursing professionals studied. A total of 5.15% of the sample studied achieves a high score in the three dimensions of the burnout syndrome. The intensive care professionals are the most vulnerable to suffering high levels of emotional exhaustion, and the masculine gender is more susceptible to depersonalization attitudes

Preliminary study of the effects of commercial lactobacilli preparations on digestive metabolism of juvenile sea bass (Dicentrarchus labrax).

Two forms of the same commercial product (SORBIAL, Allonnes, France), one with live bacteria (PSA) and the other with heat-inactivated bacteria (PSI), containing a mixture of 2 strains of lactobacilli and their growth medium were tested as a diet complement for juvenile sea bass (Dicentrarchus labrax) during a 103-day experiment. In addition to zootechnical parameters (survival, growth, conformation), some effects on digestive metabolism were studied, including enzymatic, ultrastructural and microbial aspects. Microbial preparations improved survival rate. The ventral, dorsal and operculum malformations which usually occur in juveniles did not appear in those receiving PSA and PSI. Furthermore, they stimulated, but not constantly, trypsin and acid phosphatase activities. Intestinal ultrastructure showed an increase in the number of endocytosis vesicles at the apical pole of enterocytes in fishes receiving enrichments. Bacterial flora was not modified in terms of quantity, especially the lactic acid bacteria counts, which were not changed in fishes receiving live lactobacilli (PSA). The mode of action of these multiple beneficial effects appears complex and could be caused by different molecules inside the bacterial cell or excreted into their medium.

Evidence for the involvement of pathogenic bacteria in summer mortalities of the Pacific oyster Crassostrea gigas.

A study was conducted to investigate the involvement of bacteria in oyster mortalities during summer. Moribund and apparently healthy oysters were sampled during mortality events along the French coast and in rearing facilities, usually when temperature reached 19 degrees C or higher, and oysters were in the gonadal maturation phase. Hemolymph samples were aseptically withdrawn and submitted to bacteriological analysis. In healthy oysters, bacteria colonized hemolymph at low concentrations depending on the location. In most moribund oysters, bacteria were present in hemolymph and other tissues. These bacterial populations were more often diverse in oysters originating from the open sea than from facilities where animals were generally infected by a single type of bacterium. Only the dominant colonies were identified by phenotypic and genotypic characters (RFLP of GyrB gene and partial sequence of 16S rRNA gene). They belonged to a limited number of species including Vibrio aestuarianus, members of the V. splendidus group, V. natriegens, V. parahaemolyticus, and Pseudoalteromonas sp. The most frequently encountered species was V. aestuarianus (56% of isolates), which was composed of several strains closely related by their 16S rRNA gene but diverse by their phenotypic characters. They appeared intimately linked to oysters. The species within the V. splendidus group were less prevalent (25% of isolates) and more taxonomically dispersed. A majority of the dominant strains of V. aestuarianus and V. splendidus group injected to oysters induced mortality, whereas others belonging to the same species, particularly those found in mixture, appeared innocuous.

[Effectiveness and complications of video-assisted surgery for primary spontaneous pneumothorax]. / Eficacia y morbilidad del tratamiento con cirugía videoasistida del neumotórax espontáneo primario.

OBJECTIVE: To assess the effectiveness and describe the complications of video-assisted thoracoscopic surgery (VATS) for the treatment of primary spontaneous pneumothorax. PATIENTS AND METHODS: Between May 1997 and September 2003, our department scheduled 147 VATS procedures for spontaneous pneumothorax in 127 patients (102 men [80.5%]). The mean (SD) age for the series was 28.3 (11.6) years. Bullae and blebs were resected by endostapler and vigorous pleural abrasion was carried out. Vanderschueren staging was as follows: stage I, 10 (6.8%); stage II, 22 (15%); stage III, 71 (48.3%); and stage IV, 44 (29.9%). The procedure was indicated for the following reasons: third episode, 56 (38.1%); persistent air leak, 47 (32%); elective, 16 (10.9%); simultaneous bilateral pneumothorax, 28 (19%). VATS was performed on the right side only in 85 patients (57.8%), on the left in 62 (42.2%), and on both sides in 16 (11.6%). RESULTS: A total of 137 of the 147 VATS procedures scheduled (93.2%) were performed, and there were no deaths. The rate of conversion to thoracotomy was 6.8%, and the overall rate of complications was 13.7%. Postoperative complications were due to bleeding in 5 cases (3.6%), air leak (>5 days) in 10 (7.2%), wound infection in 2 (1.4%), residual pneumothorax in 4 (2.9%), need to insert a new pleural drain in 3 (2.1%), and pleural empyema in 1 (0.7%). Two patients took oral analgesics for more than 30 days after the procedure. Pneumothorax recurred during follow-up in 7 patients (5.1%). No significant correlation was found between recurrence of pneumothorax after VATS and Vandeschueren stage, age, bilaterality of the procedure, indication, or days of postoperative drainage (P>.05). CONCLUSIONS: VATS for resection of pleural lesions plus pleural abrasion is an efficacious and simple treatment for primary spontaneous pneumothorax regardless of intraoperative findings.

[Risk factors for atrial fibrillation after thoracic surgery]. / Factores de riesgo en el desarrollo de fibrilación auricular tras cirugía torácica.

OBJECTIVE: To determine the risk factors for atrial fibrillation after lung resection. PATIENTS AND METHODS: Between January 2002 and December 2003, 149 patients underwent lung resection in our hospital. For all these patients, clinical, surgical, analytical, and oncological data were prospectively collected. The data were subjected to univariate analysis. RESULTS: The mean (SD) age of the 127 men (85.2%) and 22 women (14.8%) who underwent lung resection was 61.8 (12.3) years (range, 17-79 years). Atrial fibrillation was documented in 17 patients (11.4%). Mortality at 30 days was 8.1%. The following risk factors for atrial fibrillation were identified: age 70 years or older (P<.0004), prior heart disease (P<.005), patients undergoing operations for lung cancer (P<.04), and type of resection--right bilobectomy (P<.05) and left pneumonectomy (P<.03). Hypertension, chronic obstructive pulmonary disease, and lung cancer stage were not risk factors. Likewise, systematic lymph node dissection and other forms of lung resection were not risk factors. CONCLUSIONS: After lung resection, atrial fibrillation is a common complication that seems to be associated with old age, history of heart disease, operations for lung cancer, left pneumectomy, and right bilobectomy. The identification of these risk factors may encourage prospective studies that assess the use of antiarrhythmic drugs to prevent atrial fibrillation during chest surgery.

[Multifocal localized amyloidosis in a pediatric patient]. / Amiloidosis localizada multifocal de la vía aérea superior en una paciente pediátrica.

Amyloidosis of the upper airway is rare in the pediatric age group. We present a primary amyloidosis in the nasopharynx and nasal cavity in a 14-year-old girl. The symptoms were nasal obstruction and mucoid discharge. The diagnostic was revealed by histologycal analysis obtained from local surgical excision.

[Spontaneous hemothorax caused by lung cancer]. / Hemotórax espontáneo por carcinoma broncogénico.

Spontaneous hemothorax is an extremely rare complication of malignant disease. We describe the case of a 26-year-old man with spontaneous hemothorax secondary to large-cell carcinoma of the lung, with liver and bone metastases. The patient died in the fifth week after hospitalization.

Hemotórax espontáneo por carcinoma broncogénico / Spontaneous hemothorax caused by lung cancer

El hemotórax espontáneo como forma de presentación de una enfermedad maligna es extremadamente raro. Describimos el caso de un varón de 26 años con un hemotórax espontáneo secundario a un carcinoma broncogénico de células grandes con metástasis hepáticas y óseas que falleció en la quinta semana de ingreso

Spontaneous hemothorax is an extremely rare complication of malignant disease. We describe the case of a 26-year-old man with spontaneous hemothorax secondary to large-cell carcinoma of the lung, with liver and bone metastases. The patient died in the fifth week after hospitalization

[Medical and surgical management of noniatrogenic traumatic tracheobronchial injuries]. / Manejo médico-quirúrgico de las lesiones traqueobronquiales traumáticas no iatrogénicas.

OBJECTIVE: To describe the medical and surgical management of noniatrogenic traumatic tracheobronchial injuries. PATIENTS AND METHOD: From January 1993 to July 2004, 15 cases of traumatic tracheobronchial injury were treated in our department. The diagnosis was established by bronchoscopy and a computed tomography chest scan was performed on all patients. Surgical treatment was selected for patients with unstable vital signs, an open tracheal wound, associated esophageal lesions, progression of subcutaneous or mediastinal emphysema, mediastinitis or suspicious mediastinal secretions on imaging tests, or difficulties with mechanical ventilation due to the traumatic tracheobronchial injury. RESULTS: The mean (SD) age of the patients was 35.5 (18.9) years and 12 (80%) were male. Of the 15 cases, 13 (86.7%) had penetrating trauma and 2 (13.3%) blunt trauma. The most common location of the injury was in the bronchi (9 cases; 60%), followed by the cervical trachea (4 cases; 26.6%), followed by both the thoracic trachea and bronchi (2 cases; 13.4%). The most common initial symptom was subcutaneous emphysema, which presented in 11 (73.3%) patients. Chest (12 cases; 86.7%) and orthopedic injuries (9 cases; 60%) were the most common associated injuries. Surgery was the treatment of choice in 11 (73.3%) cases and conservative medical treatment in 4 (26.7%). An irreversible brain injury caused the death of 1 patient receiving conservative treatment. CONCLUSIONS: Tracheobronchial injuries may be treated conservatively if they meet strict selection criteria. Size and location should not be used as selection criteria for surgical treatment.

[Octreotide for conservative management of postoperative chylothorax]. / Tratamiento conservador con octreótido del quilotórax posquirúrgico.

Postoperative chylothorax after lung resection is a major problem leading to morbidity and mortality and requiring reoperation in a large number of cases. The most advisable and least aggressive option is conservative management in progressive stages: a diet rich in medium-chain fatty acids and/or total parenteral nutrition, in addition to chest tube drainage. Including octreotide in this regimen seems to be related to a higher success rate without the need for surgery. We report a case in which the effectiveness and safety of octreotide in the resolution of postoperative chylothorax was excellent.

Tratamiento conservador con octreótido del quilotórax posquirúrgico / Octreotide for conservative management of postoperative chylothorax

El quilotórax posquirúrgico tras resección pulmonar es un problema importante por su morbimortalidad y suele obligar a la reintervención en un porcentaje importante de los casos. La opción más aconsejable y menos radical es el tratamiento conservador con medidas escalonadas: dieta rica en ácidos grasos de cadena media y/o nutrición parenteral total, además de tubo de toracostomía. El uso del octreótido entre estas medidas parece estar relacionado con un índice mayor de resolución sin necesidad de un tratamiento quirúrgico. Presentamos un caso en que su efectividad e inocuidad en la resolución del quilotórax posquirúrgico fue excelente (AU)

[Malignant oncocytic papilloma. An infrequent type of sinonasal papilloma]. / Papiloma oncocítico malignizado. Una variante infrecuente de papiloma nasosinusal.

Oncocytic scheneiderian papilloma (OSP), or cylindrical cell papilloma, is the less frequent of the three morphologically distinct papillomas occurring in the nose and paranasal sinuses. We report a case of a patient with an OSP and review on the diagnostic and prognostic implications of this type of tumor.

Bacterial population association with phytoplankton cultured in a bivalve hatchery.

Bacterial populations association with phytoplankton cultures used as food for bivalve larvae were enumerated and identified from their partial 16S rDNA gene sequences. Microalgae were provided from different European hatcheries during the larval production season. Average concentration (direct counts) of bacteria ranged from 1.3 x 10(5) to 5.3 x 10(8) mL(-1) while culturable bacteria represented from 10% to >60% of total bacteria. In most cases, three to six representatives of each type of colony were collected on solid medium. The identity of isolates from the same colony type was checked by two different randomly amplified polymorphic DNA (RAPD) typing methods, after which the 16S rDNA gene of one to three isolates by colony type were partially sequenced. Algae harbored a large spectrum of bacteria belonging to the alpha-Proteobacteria, beta-Proteobacteria, gamma-Proteobacteria, Cytophaga- Flavobacterium- Bacteroides (CFB) group, Actinobacteria, and Bacillus. Members of the Roseobacter clade and CFB group were the most abundant. In the majority of cases one strain constituted 50% or more of the culturable bacterial flora. About half of the isolates were common to two hatcheries or at least two microalgal cultures. Several isolates were closely related to bacteria associated with harmful dinoflagellates in culture. Thus, the algal cultures seemed to favor certain bacterial species which belonged to distantly separated groups. As some of them could disturb the development of bivalve larvae, the control of bacterial populations would undoubtedly make it possible to reduce larval losses in bivalve rearing.

[Possible benefits of calcitonin in the treatment of otosclerosis]. / Posible beneficio de la calcitonina en el tratamiento de la otosclerosis.

This study shows the results obtained after treatment with intranasal calcitonin in 23 patients (36 ears) suffering from otosclerosis. 19.4% showed a hearing improvement upper of 10 dB. The gain was 32 dB in air conduction thresholds and 23 dB. In bone conduction. Tinnitus disappeared in 25% of cases suffering from tinnitus. Calcitonin tolerance was good, 8.7% of patients reported migraine. Authors recommended additional studies in order to evaluate the efficacy of this drug in the treatment of otosclerosis.

Vibrio carchariae, a pathogen of the abalone Haliotis tuberculata.

Since 1997, mass mortality of the abalone Haliotis tuberculata L. has occurred in the natural environment along the French coast. The outbreak of disease started on the south coast of Brittany near Concarneau in 1997, then spread to the north of Brittany (in 1998) and the west coast of Normandy (Golfe de St. Malo in 1999). Between 60 and 80% of the abalone died. In 1999, mortality also affected a land-based abalone farm in Normandy during the summer. At this farm, a Vibrio sp. was isolated in abundance from abalone that had just died. The disease was experimentally reproduced by inoculation or by introducing the pathogen into the surrounding water. This vibrio, identified by genotypic and phenotypic characters, is related to V carchariae. It is similar to the V carchariae, responsible for mortality in the Japanese abalone Sulculus diversicolor supratexta, but some phenotypic characters differentiate both strains. In 2000, healthy abalone placed in 2 sites on the north and south coasts of Brittany died, and the pathogen V carchariae could be isolated from dead individuals, demonstrating that the pathogen was probably the cause of the abalone disease that has been occurring since 1997 in Brittany.

[Laryngeal tuberculosis. Report of 4 cases]. / Tuberculosis laríngea. Exposición de 4 casos.

Reporting 4 cases of laryngeal tuberculosis seen between 1992 and 1998 in La Rioja Community. All were men tobacco addicted and alcoholism and since several months presented with dysphonia, odynophagia, dysphagia and lung aspirations. The lesions were localized in epiglottis, vocal fold, back commisure and the subglottic space. Primary complex was pulmonary. All of them were successfully treated with tuberculostsatic drugs, except one who remain with pulmonary aspirations because of a severed epiglottis.

[Descriptive epidemiology of hospital interconsultations carried out at the ORL Service for a year in the San Millan-San Pedro Hospital Complex]. / Epidemiología descriptiva de las interconsultas hospitalarias realizadas al Servicio de ORL durante un año en el Complejo Hospitalario San Millán-San Pedro.

UNLABELLED: 391 requests of collaboration to our ENT Department during 1996 have been collected. Twelve variables were analysed: number of request, age, sex, date of emission, type (ordinary, with priority, urgent), time elapsed from emission until valuation of the patient, source, reason's request, pathology, complementary tests, treatment and destination (discharge, re-examination during admission or as an outpatient and admission to ENT-Service). RESULTS: 1,58 request were attended per working day, 80 percent were resolved during the first 48 hours, the Internal Medicine Department was the most frequent source, fever without focus or recalcitrant was the most frequent reason from Paediatric Department. We report the epidemiologic features of the most frequent variables.