Asunto(s)
Betacoronavirus , Neumonía Viral , COVID-19 , Infecciones por Coronavirus , Humanos , Pandemias , SARS-CoV-2 , TraqueostomíaRESUMEN
OBJECTIVE: To assess the first three years of French activity related to liver transplantation from uncontrolled donation after cardiac death (uDCD). STUDY DESIGN: Prospective and observational study in the three active centres authorized by the French Biomedicine Agency. PATIENTS AND METHODS: All patients deceased between 2010 and 2012 after an uncontrolled cardiac arrest admitted to one of three centres (Pitié-Salpêtrière, Saint-Louis or Bicêtre hospitals, AP-HP, Paris, France) and potentially eligible for liver recovery were included. Abdominal normothermic oxygenated recirculation (ANOR) was used for graft preservation. RESULTS: One hundred twenty-six potential uDCD donors were identified as eligible for liver recovery after hospital admission. The main causes of organ recovery failure were technical failure related to ANOR (29 patients, 23%), refusal of consent (39 patients, 31% of potential uDCD donors and 40% of asked relatives) and abnormal hepatic transaminases up to 200 UI.L(-1) during ANOR (24 patients, 19%). Finally, 11 livers were transplanted. Process efficiency was 9% [95% CI: 4-15%]. One-year recipient survival was 82%, [95% CI: 48-98%] and one-year graft survival was 64% [95% CI: 31-89%]. CONCLUSION: Liver transplantation from uDCD donors is achievable in France, despite low process efficiency.
Asunto(s)
Encuestas de Atención de la Salud , Trasplante de Hígado/normas , Donantes de Tejidos/estadística & datos numéricos , Recolección de Tejidos y Órganos/normas , Adulto , Determinación de Punto Final , Femenino , Francia , Supervivencia de Injerto , Paro Cardíaco , Humanos , Circulación Hepática/fisiología , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
Increased natriuresis is a frequent situation after subarachnoid haemorrhage (SAH). It may be responsible for hyponatremia, which can be dangerous in case of severe hypo-osmolarity or hypovolemia. Inappropriate secretion of antidiuretic hormone or cerebral salt wasting syndrome (CSWS) have been incriminated for hyponatremia after SAH, but it remains difficult to distinguish between both syndromes. There are many explanations for increased natriuresis after SAH, depending on the level of blood pressure, the volemia, and the presence or not of natriuretic peptides. The cerebral insult and the treatments, which are done to fight against elevated intracranial pressure or vasospasm, can modify any of these parameters. So it appears that the word "cerebral" in CSWS is probably not a good term and it would be better to talk about appropriate or non-appropriate natriuretic response. Corticoïds or urea can be useful for controlling hypernatriuresis.
Asunto(s)
Encefalopatías/etiología , Hiponatremia/fisiopatología , Hipovolemia/fisiopatología , Natriuresis , Corticoesteroides/uso terapéutico , Presión Sanguínea , Encefalopatías/tratamiento farmacológico , Encefalopatías/epidemiología , Encefalopatías/fisiopatología , Diagnóstico Diferencial , Humanos , Hiponatremia/tratamiento farmacológico , Hiponatremia/epidemiología , Hipovolemia/tratamiento farmacológico , Hipovolemia/epidemiología , Síndrome de Secreción Inadecuada de ADH/tratamiento farmacológico , Síndrome de Secreción Inadecuada de ADH/epidemiología , Síndrome de Secreción Inadecuada de ADH/fisiopatología , Incidencia , Urea/uso terapéuticoRESUMEN
Bacterial meningitis is still associated with a high mortality, mainly because of cerebral herniation as a result of increased intracranial pressure. Published data stress the necessity of an early diagnosis and immediate start of antibiotic therapy. Nevertheless, there are only few reports in which therapeutic strategy was based on the monitoring and the reduction of intracranial pressure (ICP). We report one case of bacterial meningitis caused by Neisseria meningitidis with an initial ICP value of 60 mmHg, which was treated by large hemicraniectomy and ventriculostomy, leading to a favorable neurological long-term result. The surgical decision was accelerated by an accurate ICP evaluation based on cerebral monitoring [transcranial Doppler ultrasonography (TCD) and intracranial ICP-device]. In selected patients with bacterial meningitis and clinical and radiological evidence of elevated ICP, cerebral monitoring and aggressive reduction of ICP may be crucial to improve survival and neurological outcome. When maximal medical ICP treatment fails to reduce severe intracranial hypertension, decompressive craniectomy should be rapidly proposed.