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1.
Emergencias (St. Vicenç dels Horts) ; 21(5): 325-332, oct. 2009.
Artigo em Espanhol | IBECS | ID: ibc-84434

RESUMO

Objetivos: Investigar la evolución clínica de los síntomas y comprobar la seguridad del alta directa desde el servicio de urgencias hospitalario (SUH) en mujeres afectadas depielonefritis aguda (PNA) no complicada. Método: Estudio prospectivo, longitudinal, no intervencionista y multicéntrico de pacientes procedentes de 2 SUH diferentes con PNA no complicada cuya permanencia en el SUH fuese inferior o igual a 24 horas. Se recogieron antecedentes, datos de la enfermedad actual, exploraciones complementarias y tratamiento prescrito. A los 3-5días del alta se contactó telefónicamente para valorar su curación clínica (resoluciónde la fiebre, el dolor lumbar y el síndrome miccional) y, en caso de persistir algún síntoma, se contactó de nuevo a los 7-10 días. Se registraron las reconsultas y si ellohabía comportado cambios en el tratamiento y/o había requerido hospitalización. Resultados: Se incluyeron 71 mujeres, el 83% presentaba curación completa a los 10días del alta del SUH. Las curvas de curación resultaron casi superponibles en ambos SUH (p = NS). El dolor lumbar fue el síntoma que más tardó en desaparecer (p < 0,01respecto a la fiebre y el síndrome miccional). Reconsultaron 12 pacientes (16,9%) y sólo2 de ellas (2,8%) tuvieron que ser hospitalizadas. Algún factor se relacionó con la mayor persistencia de algún síntoma en concreto, pero ninguno con una curación más precoz. Conclusiones: La mayoría de las pacientes diagnosticadas de PNA no complicada alcanzan la curación clínica sin necesidad de hospitalización, por lo que es seguro proceder al alta directa desde el SUH tras un periodo de observación que permita administrarla primera dosis de antibiótico parenteral, elegir un antibiótico oral adecuado, advertir a la paciente de la posible duración prolongada de algunos síntomas y remitirla a un control ambulatorio adecuado (AU)


Objective: To determine the clinical course and safety of patients discharged home after hospital emergency department treatment of acute uncomplicated pyelonephritis. Methods: This prospective, longitudinal, nonintervention, multicenter study enrolled women diagnosed with acute uncomplicated pyelonephritis at 2 hospital emergency services. No patient stayed in the emergency room longer than24 hours. Medical history, current complaints, test results, and prescribed treatment were recorded for all patients. Between 3 to 5 days after discharge the patient was telephoned to assess clinical course (resolution of fever, lower backpain, and urinary tract symptoms). If symptoms persisted, the patient was called again between 7 and 10 days after discharge. The caller asked if the patient had consulted another doctor and if that consultation led to changes in treatment and/or hospitalization was required. Results: Seventy-one patients were enrolled; 83% experienced complete resolution within 10 days of discharge. The survival curves of cures were practically identical for the 2 emergency services (no significant difference). Lower back pain was the symptom that took the longest to resolve (P<.01, with respect to both fever and urinary tract symptoms).Twelve patients (16.9%) consulted a doctor again and only 2 (2.8% of the entire cohort) had to be hospitalized. Although certain factors were associated with longer duration of certain symptoms, no particular factor was found to correlate with early resolution. Conclusions: Most patients diagnosed with acute pyelonephritis are cured without requiring hospitalization. Discharge home from the emergency department is therefore justified after an observation period in which a first parenteral antibiotic dose is administered and an appropriate oral antibiotic is chosen. The patient should be warned of the possibility of the persistence of some symptoms and referred for appropriate outpatient follow-up (AU)


Assuntos
Humanos , Feminino , Pielonefrite/epidemiologia , Infecções Urinárias/epidemiologia , Estudos Prospectivos , Assistência Ambulatorial/métodos , Recidiva , Pielonefrite/diagnóstico , Pielonefrite/tratamento farmacológico
2.
Arch Esp Urol ; 58(6): 491-6, 2005.
Artigo em Espanhol | MEDLINE | ID: mdl-16138759

RESUMO

OBJECTIVES: Living donors for kidney transplantation have attracted interest from different points of view because medical issues are accompanied by other features involving ethical, legal and social issues. We analyze all aspects involved in living donation for kidney transplantation. METHODS: We analyze: (1) ETHICAL ISSUES: requirements to become living donor, donor-receptor relationship, informed consent, donor's motivations, risk/benefit. (2) Legal issues: We review Spanish laws and Council of Europe's recommendations. (3) We also analyze how to coordinate the process in order to guarantee protection to donors. RESULTS/CONCLUSIONS: Living donor kidney transplantation is a growing therapeutic option. The process of living donation should comply with several legal and ethical requirements, and cooperation between different professionals to guarantee protection to donors.


Assuntos
Transplante de Rim , Doadores Vivos/ética , Doadores Vivos/legislação & jurisprudência , Obtenção de Tecidos e Órgãos/ética , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Humanos , Espanha
3.
Arch. esp. urol. (Ed. impr.) ; 58(6): 491-496, jul.-ago. 2005.
Artigo em Espanhol | IBECS | ID: ibc-039562

RESUMO

OBJETIVO: El donante vivo renal hagenerado interés desde distintos puntos de vista, ya queal tema puramente médico se añaden otros aspectosque abarcan cuestiones éticas, legislativas, sociales...Se trata por tanto de analizar todos aquellos aspectosque se derivan de la donación de vivo.MÉTODO: Se analizan desde el punto de vista ético:los requisitos que debe tener un donante vivo, el tipo derelación donante-receptor, cómo debe ser el consentimientoinformado, las motivaciones del donante, larelación riesgo/beneficio. Desde el punto de vistalegal: se revisa la legislación española y las recomendacionesdel Consejo de Europa. Se analiza tambiéncómo coordinar el proceso para garantizar la proteccióndel donante.RESULTADOS/CONCLUSIONES: El trasplante deriñón con donante vivo es una alternativa terapéuticacada vez más extendida. El proceso de la donación devivo debe cumplir una serie de requisitos legales y éticos,y la colaboración de diferentes profesionales paragarantizar una correcta protección del donante


OBJECTIVES: Living donors for kidney ;;transplantation have attracted interest from different ;;points of view because medical issues are accompanied ;;by other features involving ethical, legal and social ;;issues. We analyze all aspects involved in living donation ;;for kidney transplantation. ;;METHODS: we analyze: 1. Ethical issues: requirements ;;to become living donor, donor-receptor relationship, ;;informed consent, donor’s motivations, risk/benefit. 2. ;;Legal issues: We review Spanish laws and Council of ;;Europe’s recommendations. 3. We also analyze how to ;;coordinate the process in order to guarantee protection ;;to donors. ;;RESULTS/CONCLUSIONS: Living donor kidney transplantation ;;is a growing therapeutic option. The process ;;of living donation should comply with several legal and ;;ethical requirements, and cooperation between ;;different professionals to guarantee protection to ;;donors


Assuntos
Humanos , Transplante de Rim , Doadores Vivos/ética , Doadores Vivos/legislação & jurisprudência , Espanha
4.
Am J Transplant ; 5(4 Pt 1): 781-7, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15760402

RESUMO

Bacterial infections are frequent in cadaveric organ donors and can be transmitted to the transplantation recipient, which could have devastating consequences for the recipients if adequate preventive measures are not adopted. From the 355 consecutive brain dead cadaveric organ donors procured at our center in the last four years, 2000-2003, four of them (1.1%) had bacterial endocarditis as cause of death. The bacteria responsible for the endocarditis were Staphylococcus epidermidis, coagulase-negative Staphylococcus, Staphylococcus hominis and Streptococcus viridans, respectively. We performed five kidney and two liver transplantations on seven recipients. All donors and recipients received antibiotic treatment against the germ causing the respective endocarditis. Infection by the bacteria responsible for the endocarditis in the respective donors was not transmitted to any of the recipients. Six of the seven recipients were alive with normal-functioning grafts after between 13 and 24 months' follow-up. Transplantectomy was performed on one kidney recipient due to thrombosis of the renal vein of the graft not related to the endocarditis. Liver and kidney transplantation from donors dying from bacterial endocarditis can be performed without causing the transmission of infection to the recipient or the dysfunction of the graft.


Assuntos
Endocardite Bacteriana , Transplante de Rim , Transplante de Fígado , Infecções Estafilocócicas , Doadores de Tecidos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Staphylococcus epidermidis , Staphylococcus hominis , Obtenção de Tecidos e Órgãos
5.
Med Sci Monit ; 10(9): CS49-53, 2004 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-15328490

RESUMO

BACKGROUND: The enzymatic analysis of mitochondrial respiratory chain (MRC) complexes of skeletal muscle is an important step in the diagnosis of mitochondrial disorders. Because of its lesser turbidity and increased sensitivity, mitochondrial fractionation has been increasingly considered the diagnostic method of choice compared with the more classical analysis of muscle homogenate. In circumstances in which mitochondria become abnormal in number, size or shape, the process of mitochondrial enrichment made by sequential centrifugation and washing may favor the selection of the most normal mitochondria, eliminating the most abnormal ones. In this situation, the study of muscle homogenate, paradoxically, may better reflect what happens in vivo. CASE REPORT: To exemplify this situation we present a 60-year-old woman with a complete mitochondrial phenotype and a 70% heteroplasmic presence of the mtDNA A3243G mutation in muscle tissue. The respiratory and enzymatic activities from mitochondria-enriched muscle suspension were within normal control limits. In contrast, when muscle homogenate was studied, enzyme activities of complexes I, III, and V were found to be decreased. CONCLUSIONS: Although mitochondria-enriched muscle suspensions are usually more informative than muscle homogenates for studies of MRC, in some situations it may be necessary to study both to uncover the biochemical defect.


Assuntos
Miopatias Mitocondriais , Músculo Esquelético/citologia , Músculo Esquelético/fisiopatologia , Fosforilação Oxidativa , Biópsia , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Fracionamento Celular , DNA Mitocondrial/análise , Transporte de Elétrons , Complexo de Proteínas da Cadeia de Transporte de Elétrons/genética , Complexo de Proteínas da Cadeia de Transporte de Elétrons/metabolismo , Feminino , Humanos , Pessoa de Meia-Idade , Mitocôndrias/enzimologia , Mitocôndrias/genética , Mitocôndrias/ultraestrutura , Miopatias Mitocondriais/diagnóstico , Miopatias Mitocondriais/enzimologia , Miopatias Mitocondriais/patologia , Miopatias Mitocondriais/fisiopatologia , Músculo Esquelético/metabolismo , Músculo Esquelético/patologia , Radiografia , Extratos de Tecidos/química , Extratos de Tecidos/metabolismo
6.
J Gerontol A Biol Sci Med Sci ; 57(6): M378-84, 2002 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-12023267

RESUMO

BACKGROUND: Muscle complaints are frequent among older adults, but histological data in this setting are scarce. Our objective was to detect the major categories of muscle diseases in the elderly population based on histological study. METHODS: We reviewed all muscle biopsies performed in our hospital on patients older than the age of 65 during a 10-year period (1988-1997). As a control group, we included the next patient younger than 65 who underwent muscle biopsy after each elderly patient. We recorded demographic, clinical, and histological data of the patients, as well as the final diagnosis. Concordance between pre- and postbiopsy diagnosis was also analyzed. RESULTS: We included 239 muscle biopsies corresponding to elderly patients and 239 to controls. Compared with the control group, elderly patients more frequently exhibited type II fiber atrophy and were diagnosed with a specific myopathy. The latter was achieved in 86 cases (36%), idiopathic inflammatory myopathies and vasculitis being the most frequent diagnoses. Interestingly, in about one quarter of the elderly patients in whom a definite diagnosis of muscle disease was achieved, this diagnosis had not been clinically suspected prior to muscle biopsy. Overall, in 60 out of 239 elderly patients (25%), a specific therapeutic regimen could be instituted on the basis of the muscle biopsy results. CONCLUSIONS: Muscle diseases are not rare in elderly patients. Therefore, muscle biopsy constitutes a safe and useful tool for diagnosis because, if not performed, some potentially treatable diseases may be undiagnosed or misdiagnosed.


Assuntos
Doenças Musculares/epidemiologia , Doenças Musculares/patologia , Doenças Neuromusculares/epidemiologia , Doenças Neuromusculares/patologia , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha , Estudos de Casos e Controles , Feminino , Humanos , Incidência , Masculino , Músculo Esquelético/patologia , Razão de Chances , Probabilidade , Valores de Referência , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Espanha/epidemiologia
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