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During 2005, 1546 true solid organ donors were registered in Spain, yielding a rate of 35.1 per million population (pmp), which places our country at the head of word-wide donation rates. A total of 2200 kidney transplantations were performed in Spain during 2005, 72 of them in infants and children. The cadaveric kidney transplantation rate was 47.9 pmp, the highest in the world for this type of transplant. The 2005 Spanish Renal Transplant Registry showed that patient mortality associated with these transplants is 1.6%. Graft survival is 90% to 84% at the first year and 76% to 66% at 5 years. Furthermore, in 2005, 1070 liver transplantations (24.1 pmp) were carried out. Patient survival in this group is 81.3% the first year, 73.3% at 3 years, 56.7% at 10 years and 26.8% at 20 years. A total of 287 heart transplantations were undertaken (6.5 pmp). Patient survival is 86% to 81% the first year, and around 70% at 5 years. There were 167 lung transplantations, 112 double and 55 single lung transplants. Patient survival in this population is 79.3% the first year and 45.2% at 5 years. Lastly, pancreas transplant activity has increased considerably in recent years, with 96 transplants during 2005.

Objective: To analyze and compare the prognostic value of the pediatric index of mortality (PIM) score and lactate values on admission to a pediatric intensive care unit (PICU)., Patients and Methods: We performed a prospective study of 500 consecutive children: 237 girls (47.4 %) and 263 boys (52.6 %) with a mean age of 51.5 59.7 (range: 3 days-18 years) admitted to our PICU. PIM scores and blood lactate concentrations were determined on admission. The predictive ability of PIM and lactate concentrations in relation to mortality and length of stay in the PICU were analyzed., Results: Thirty-six patients (7.2 %) died. According to the PIM score, the mean probability of death in children who died was 23.6 % 28.9, which was significantly higher than that in surviving children (3.4 % 7.3; p < 0.001). The area under the ROC curve for PIM was 0.81 0.03 (95 % CI: 0.74-0.89). Lactate level in nonsurvivors was 4.9 % 3.5 mmol/L, which was significantly higher than that in survivors (1.9 % 1.5 mmol/L; p < 0.001). The area under the ROC curve for blood lactate was 0.76 0.04 (95 % CI: 0.67-0.85). No statistically significant differences were found between either ROC curves. In survivors, a significant relationship was found between PIM score and length of stay in the PICU while in nonsurvivors an inverse relationship was found between blood lactate concentrations and length of stay., Conclusions: Both PIM score and blood lactate concentrations on admission to the PICU have a moderate prognostic value in critically-ill children. The prognostic value of the PIM score is greater than that of blood lactate concentration but is more difficult to obtain, whereas blood lactate determination is fast and easy.

Objective: To ascertain the incidence of osteoporosis and epidemiological factors in patients admitted to an Internal Medicine Service of a University General Hospital in Madrid, Spain. We also took into account the reasons for admission, associated diseases, and the preventive and therapeutic diagnostic implications., Patients and Methods: The analytical, descriptive, retrospective and transversal study of one hundred patients over fifty years of age admitted to an internal medicine service during 1997, obtaining in addition to the clinical discharge report, epidemiological data with regard to the radiological diagnosis of osteoporosis, the reason for admission, past history, the prevention and treatment of the initial complaint as well as the osteoporosis previous diagnosis., Results: 26% of those patients included in the survey had radiologic criteria of osteoporosis although only in 1 per cent of them had osteoporosis been diagnosed previously. The main risk factors, apart from the age and sex, are the associated illnesses which cause malnutrition and immobilization, and the use of drugs, especially heparin., Conclusions: Osteoporosis is a condition common in patients above 50 especially women, who are admitted to an Internal Medicine Service. A quarter of those patients admitted have osteoporosis. Very few are diagnosed and treated. In this group of patients apart from the habitual risk factors, are added those for the associated disease generally chronic, and the treatment they receive. During their stay in the hospital osteoporotic patients are three times more likely to receive heparin and other drugs which aggravate osteoporotic, than non osteoporotic patients. For that reason the risk of fractures is greater and the need for prospective diagnostic studies is even more necessary in this group of patients.

Objective: Our aim was to analyze if inhaled nitric oxide (NO) allows a reduction in respiratory assistance during the first 24 hours of treatment of children with acute respiratory distress syndrome (ARD) and/or pulmonary hypertension (PHT)., Patients and Methods: We studied 53 children with ARDS and/or PHT refractory to conventional therapy who were treated with inhaled nitric oxide at least 24 hours at 1.5 to 45 ppm. We compared respiratory assistance (peak pressure, PEEP and FiO2) and oxygenation parameters (PaO2/FiO2 ratio and oxygenation index) before and after 6 and 24 hours of treatment., Results: In 45 of 53 children NO improved oxygenation (increase of PaO2/FiO2 > 20%). At six hours of treatment the PaO2/FiO2 ratio increased 31 points, the oxygenation index diminished 4.5 points, and the FiO2 was decreased 11 points without significant changes in peak pressure and PEEP. At 24 hours the PaO2/FiO2 ratio was increased 4 points, the oxygenation index diminished 7.3 points and the FiO2 decreased 18 points in relationship to the initial parameters., Conclusions: The effect of inhaled nitric oxide on oxygenation remains during the first 24 hours and permits a decrease in the FiO2.

Background: Osteoporosis may be associated with parenchymal hepatopathy and chronic alcoholism. Biochemical studies which are linked with bone metabolism and the bone densitometry may help to understand its physiopathology, before the symptoms appear and its consequences become inevitable., Patients and Methods: The study of bone metabolism and densitometry has been carried out in a population of 86 males, distributed in 4 groups: group I, control (17 men), group II, patients with chronic hepatopathy without alcoholism (25 patients), group III, chronic alcoholic without hepatopathy (21 patients), and group IV, patients with chronic alcoholic hepatopathy (23 patients). The results of densitometry and biochemical parameters in relation with bone metabolism are cross checked among these 4 groups., Results: We found out that patients with chronic alcoholic hepatopathy have bone mineral density (BMD), at femoral level, significatively lower than that of the other 3 groups (p < 0.05). In chronic hepatopathy, regardless of its etiology, significant alterations in biochemical parameters of bone metabolism found, consisting basically in shrinked plasmatic level of 25-hydroxivitamin-D (25-OH-D) (p < 0.05). The plasmatic levels of calcitriol, magnesium and intact parathyroid hormone (PTHi) were significantly lower in chronic alcoholic hepatopathy than in the others 3 groups (p < 0.001, p < 0.001 and p < 0.05, respectively)., Conclusions: Chronic hepatopathy is associated with deficiency in vitamin D. Alcoholism added to chronic hepatopathy has a negative influence on the plasmatic levels of calcitriol, magnesium and PTHi as well as in the femur BMD. Alcoholism not associated with chronic hepatopathy is not sufficient to cause significant alterations in the studied parameters.

Background: Nosocomial infections, especially in the intensive care unit, are a very important problem due to their frequency and important consequences (morbility and mortality). On the other hand there are some risk factors and some preventive measures which are involved in the appearance of the nosocomial infections. The purpose of this work was to recognize these risk factors and to identify the preventive measures which are effective, and also to quantify the participation of each risk factors/preventive measures in the development of the nosocomial infections., Patients and Methods: Follow-up of a cohort of patients admitted to the intensive care unit of the General Hospital of La Paz (Madrid, Spain) during a year and with a stay of at least 48 hours., Results: We have found a cummulative incidence of patients with nosocomial infection of 32.8%. More than 80% of the patients received antibiotic treatment during their stay in the intensive care unit. The stay of the patients no infected was 4 days while the stay of infected patients was 20 days. We have found a mortality of 29.5%, which was greater in the patients who were infected (42%). In the multivariate analysis we have developed an equation to predict the development of the nosocomial infection. The following variables were identified: six or more instrumentations (OR, 4.75; 95% CI, 2.75-8.19), more of ten days of hospitalization previous to the appearance of the first nosocomial infection (OR, 4.17; 95% CI, 2.60-6.70), administration of muscle relaxing drugs (OR, 2.25; 95% CI, 1.43-3.55), nasogastric tube (OR, 2.19; 95% CI, 1.25-3.84), and altered consciousness (OR, 2.19; 95% CI, 1.25-3.84). Therefore, those patients who present some of these characteristics should be monitored in a special way due to their high risk of development of a nosocomial infection., Conclusions: Several factors play an important role in the development of a nosocomial infection in the intensive care unit; these are not only intrinsec (especially the altered consciousness) but also extrinsec (instrumentations and drugs), as well as the stay at the hospital previous to the appearance of the first nosocomial infection.

An evaluation was made of the appropriateness of hospital admissions in the ear, nose, and throat surgery department of a teaching hospital. One hundred fifty-two clinical histories were studied. Elective surgery admissions were reviewed using the new Appropriateness Evaluation Protocol (AEP) for elective surgery. Non-elective admissions and the duration of the hospital stay were reviewed with the adult medical-surgical AEP. In the patients who underwent elective surgery, admission was inappropriate in 6.2% (95% confidence interval: 2.9-12.2%). Name of the non-elective admissions (95% confidence interval: 0-17.8%) was inappropriate. Nineteen per cent of hospital days were inactive (95% confidence interval: 13.3-26.4%).