Estapedectomía, otitis media y meningitis recidivante / Stapedectomy, otitis media and recurrent meningitis

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Sarcoma en arteria pulmonar como causa de hemoptisis aislada / Pulmonary artery primary sarcoma as isolated hemoptysis

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[Acute renal failure in lung transplantation: incidence, correlation with subsequent kidney disease, and prognostic value]. / Insuficiencia renal aguda y trasplante pulmonar: incidencia, correlación con patología renal posterior y valor pronóstico.

OBJECTIVE: We studied the incidence of postoperative renal failure and its association with mortality in lung transplant patients in our hospital classified according to the severity of renal failure in the immediate postoperative period, and at 30 days, 6 months, and 1 year after transplantation. MATERIAL AND METHODS: For the period March 1997 through January 2006, 144 lung transplants were performed in our hospital. Six patients were lost to follow-up. Patients were assigned to 1 of the 5 Chronic Kidney Disease (CKD) classes according to the glomerular filtration rate on admission to the intensive care unit, and at 1 month, 6 months, and 12 months. Descriptive statistics were calculated for the sample. The relationship between the CKD classification and mortality was analyzed by calculating the odds ratio with a logistic regression model. The correlation between CKD classification on admission and at 1 month, 6 months, and 1 year after transplantation was analyzed using the Spearman correlation coefficient. RESULTS: Of the 144 patients analyzed, 52 patients were in CKD class 1, 63 in class 2, 19 in class 3, 2 in class 4, and 2 in class 5, according to the glomerular filtration rate. The correlation between mortality at 1 month and CKD classification on admission was not statistically significant (odds ratio, 1.11; 95% confidence interval, 0.42-3.11; P=.82) among patients with normal kidney function (CKD class 1) and those with some degree of renal failure (CKD classes 2-5). There was no correlation between CKD classification on admission and CKD classification at 1 month, 6 months, and 1 year although a significant positive correlation was found between CKD classification at 1 month and CKD classes at 6 months and 1 year. CONCLUSIONS: We did not find any association between 1-month mortality and the degree of renal failure in the immediate postoperative period in lung transplant patients. There was a positive correlation between the degree of kidney failure at 1 month and that observed 6 and 12 months after the procedure.

Insuficiencia renal aguda y trasplante pulmonar: incidencia, correlación con patología renal posterior y valor pronóstico / Acute renal failure in lung transplantation: incidence, correlation with subsequent kidney disease, and prognostic value

OBJETIVO: Presentamos un análisis de incidencia de disfunción renal y mortalidad de los pacientes a quienes se practicó un trasplante pulmonar en nuestro centro según el grado de insuficiencia renal que desarrollaron en el postoperatorio inmediato, a los 30 días, a los 6 meses y al año de realizado el trasplante. MATERIAL Y MÉTODOS: Durante el período definido (de marzo de 1997 a enero de 2006) se realizaron 144 trasplantes de pulmón en nuestro centro. Hubo 6 pérdidas en el seguimiento de los pacientes. Se clasificó a los pacientes en 5 grupos dependiendo del valor del filtrado glomerular en el momento de ingreso en la unidad de cuidados intensivos, al mes, a los 6 y 12 meses de realizado el trasplante, según la clasificación Chronic Kidney Disease (CKD). Se realizó un análisis estadístico descriptivo de la muestra. Se estudió la relación entre el CKD y la mortalidad, medida como odds ratios, mediante regresión logística. Se realizó un análisis de correlación entre el CKD al ingresar, al mes, a los 6 meses y al año de realizado el trasplante mediante el coeficiente de correlación de Spearman. RESULTADOS: De los 144 pacientes analizados, se clasificó, atendiendo al filtrado glomerular, a 52 en el grupo I, a 63 en el grupo II, a 19 en el III, a 2 en el IV y a otros 2 en el V. La asociación entre mortalidad al mes y CKD al ingresar no evidenció significación estadística (odds ratio = 1,11; intervalo de confianza del 95%, 0,42-3,11; p = 0,82) entre los pacientes con función renal normal (CKD 1) y aquéllos con algún grado de insuficiencia renal (CKD 2-5). No se encontró correlación entre el CKD al ingreso y el CKD al mes, a los 6 meses y al año. Sin embargo, se halló una correlación positiva (significativa) entre el CKD al mes y el CKD a los 6 meses y al año. CONCLUSIONES: No encontramos diferencias de asociación con la mortalidad al mes atendiendo al grado de insuficiencia renal en el postoperatorio inmediato de los pacientes con trasplante de pulmón. Existe una correlación positiva entre el grado de insuficiencia renal al mes y el observado a los 6 y 12 meses de realizado el trasplante

OBJECTIVE: We studied the incidence of postoperative renal failure and its association with mortality in lung transplant patients in our hospital classified according to the severity of renal failure in the immediate postoperative period, and at 30 days, 6 months, and 1 year after transplantation. MATERIAL AND METHODS: For the period March 1997 through January 2006, 144 lung transplants were performed in our hospital. Six patients were lost to follow-up. Patients were assigned to 1 of the 5 Chronic Kidney Disease (CKD) classes according to the glomerular filtration rate on admission to the intensive care unit, and at 1 month, 6 months, and 12 months. Descriptive statistics were calculated for the sample. The relationship between the CKD classification and mortality was analyzed by calculating the odds ratio with a logistic regression model. The correlation between CKD classification on admission and at 1 month, 6 months, and 1 year after transplantation was analyzed using the Spearman correlation coefficient. RESULTS: Of the 144 patients analyzed, 52 patients were in CKD class 1, 63 in class 2, 19 in class 3, 2 in class 4, and 2 in class 5, according to the glomerular filtration rate. The correlation between mortality at 1 month and CKD classification on admission was not statistically significant (odds ratio, 1.11; 95% confidence interval, 0.42-3.11; P=.82) among patients with normal kidney function (CKD class 1) and those with some degree of renal failure (CKD classes 2-5). There was no correlation between CKD classification on admission and CKD classification at 1 month, 6 months, and 1 year although a significant positive correlation was found between CKD classification at 1 month and CKD classes at 6 months and 1 year. CONCLUSIONS: We did not find any association between 1-month mortality and the degree of renal failure in the immediate postoperative period in lung transplant patients. There was a positive correlation between the degree of kidney failure at 1 month and that observed 6 and 12 months after the procedure

[Liver trauma. Description of a cohort and evaluation of therapeutic options]. / Traumatismo hepático. Descripción de una cohorte y valoración de opciones terapéuticas.

INTRODUCTION: Complex liver injuries carry high morbidity and mortality ranging between 40 and 80%. OBJECTIVES: To describe the characteristics of patients with liver trauma in the intensive care unit of our hospital, and the causes, severity scales, diagnoses, and treatments of these injuries, as well as length of hospital stay, morbidity and mortality. PATIENTS AND METHOD: We retrospectively reviewed the patients with liver trauma admitted to our intensive care unit (ICU) from January 2000 to December 2005. There were two groups of patients: those who underwent surgery and those who received conservative treatment. RESULTS: Univariate analysis revealed statistically significant differences between the two groups in the Acute Physiology and Chronic Health Evaluation II (APACHE II) score on admission to the ICU, the Injury Severity Score (ISS), and the percentage of severelesions according to the Liver Injury Scale (LIS), as well as in the coexistence of lesions in the large intestine. CONCLUSIONS: From the statistical point of view, the two main variables guiding the therapeutic approach were hemodynamic instability and the need for transfusion. The indication for surgery showed a clear, although non-significant, association with mortality. Lastly, there was an association between the surgical option of packing and mortality.

Traumatismo hepático. Descripción de una cohorte y valoración de opciones terapéuticas / Liver trauma. Description of a cohort and evaluation of therapeutic options

Objetivos. Describir las características de los pacientes con traumatismo hepático ingresados en la Unidad de Cuidados Intensvos (UCI) de nuestro hospital, los mecanismos lesionales, las escalas de gravedad, los diagnósticos y los tratamientos, así como la estancia hospitalaria y la morbimortalidad. Pacientes y método. Se han analizado de forma retrospectiva los casos de traumatismo hepático que ingresaron en nuestra unidad de cuidados intensivos desde enero de 2000 hasta diciembre de 2005. Se diferenciaron dos grupos de pacientes según la opción terapéutica utilizada: pacientes intervenidos quirúrgicamente y pacientes tratados de forma conservadora. Resultados. Comparando las características de los pacientes sometidos a uno u otro tipo de tratamiento, comprobamos, mediante análisis univariable, que hubo diferencias estadísticamente significativas entre ambos grupos en la puntuación de la escala de gravedad APACHE II al ingreso en UCI, el Injury Severity Score (ISS), el porcentaje de lesiones hepáticas graves según la Liver Injury Scale (LIS), así como la concomitancia de lesión en el intestino grueso relacionada. Conclusiones. La inestabilidad hemodinámica y la necesidad de transfusión han sido, desde el punto de vista estadístico, las dos principales variables en las que se apoyó la decisión de la opción terapéutica que desarrollar. La indicación quirúrgica sin llegar a la significación estadística presenta una clara tendencia a tener relación con la mortalidad. Por último, también encontramos asociación entre la opción quirúrgica de realizar packing y mortalidad (AU)

Introduction. Complex liver injuries carry high morbidity and mortality ranging between 40 and 80%. Objectives. To describe the characteristics of patients with liver trauma in the intensive care unit of our hospital, and the causes, severity scales, diagnoses, and treatments of these injuries, as well as length of hospital stay, morbidity and mortality. Patients and method. We retrospectively reviewed the patients with liver trauma admitted to our intensive care unit (ICU) from January 2000 to December 2005. There were two groups of patients: those who underwent surgery and those who received conservative treatment. Results. Univariate analysis revealed statistically significant differences between the two groups in the Acute Physiology and Chronic Health Evaluation II (APACHE II) score on admission to the ICU, the Injury Severity Score (ISS), and the percentage of severelesions according to the Liver Injury Scale (LIS), as well as in the coexistence of lesions in the large intestine. Conclusions. From the statistical point of view, the two main variables guiding the therapeutic approach were hemodynamic instability and the need for transfusion. The indication for surgery showed a clear, although non-significant, association with mortality. Lastly, there was an association between the surgical option of packing and mortality (AU)