Addressing a Diagnosis of Brain Death in Hypernatremia Situation

Hypernatremia and the state of plasma hypertonia are part of the alterations of insipid diabetes that are integrated to the brain death (BD) syndrome. Hypernatremia should be corrected as early as possible to make the clinical diagnosis of BD and to avoid its potential deleterious effect on the subsequent operation of the liver graft. Transcranial Doppler is a very valuable tool for the diagnosis of cerebral circulatory arrest associated with BD. The correction of natremia is made through the use of hypotonic solutions, and using of pyrogen-free distilled water intravenously in special cases, which controls the possibility of hemolysis in the donor. In our study, isolated severe hypernatremia corrected before ablation was not associated with liver graft failure in the recipient.

Organ Donation and Primary Central Nervous System Tumors

Primary central nervous system tumors can be the cause of brain death. Not all of them contraindicate the donation of organs and tissues for transplant. A survey of cases was carried out in our country in which it was observed that the number of brain deaths caused by primary tumors was low, of the order of 2%, with an ẋ (media) of 3 by year, which would increase the potential for donation. Medical records, an anatomopathologic study, and a detailed physical examination will be fundamental when applying the donor selection criteria. Nuclear magnetic resonance in expert hands has a sensitivity of 96% to catalog the benignity or malignancy of this type of tumors.

Does Traumatic Brain Injury by Firearm Injury Accelerates the Brain Death Cascade? Preliminary Results

Brain death (BD) triggers a series of pathophysiological events similar to multiple-organ dysfunction. Traumatic brain injury (TBI) due to firearm injury (FAI) causes lesions that could lead to BD. Patients admitted to the ICU due to severe TBI that evolved to BD were studied, including those caused by FAI; the 2 groups were compared with the objective of demonstrating that the support of the deceased donor by TBI due to FAI is more unstable and of shorter duration than the one related to TBI by another cause. Preliminary results demonstrated that the individuals with TBI by FAI died in BD in a higher percentage than the individuals with TBI caused by accidents (83% vs 41%). The donor treatment period was lower in individuals who presented TBI by FAI. These individuals needed higher doses of noradrenaline as vasopressor support for their treatment, without showing a statistically significant difference (P = .15), compared with individuals whose BD cause was TBI caused by accident.

Systodiastolic Separation Expresses Cerebral Circulatory Arrest?

There is a situation before the cerebral circulatory cessation phase, the systodiastolic separation in transcranial Doppler (TCD), which may raise doubts to the operator technician who performs it. A total of 266 studies were performed in 188 neurocritical patients over a 9-year period: 88 cases (77%) corresponded to cerebral circulatory arrest (CCA) which accompanies brain death (BD); 9 (5%) presented the systodiastolic separation pattern. In 1 of those 9 there was persistence of cough reflex and spontaneous breathing; in 5, CCA was not reached; only 3 evolved to CCA. The finding of a minimal persistent neurologic semiology is a categoric fact that would rule out the clinical correlation between this pattern and BD diagnosis.

Traumatic dislocation of posterior tibial tendon by avulsion of flexor retinacular release. Reconstruction with suture anchors

INTRODUCTION

Traumatic dislocation of the posterior tibial tendon (PTT) has a very low prevalence. It presents with pain and recurrent snapping on the posterior side of the medial malleolus after an ankle sprain while practicing sports. The diagnosis is based on clinical examination, supported by imaging techniques. The treatment must be always surgical.

CASE REPORT

A 28 year old man sprained ankle his ankle while jogging. He was treated in an emergency department with an elastic bandage. Once he recovered, he went back to running, noticing a projection with ankle pain. In the physical examination the PTT was reproduced with inversion maneuvers and forced dorsiflexion. Ultrasound and MRI were performed on the ankle. The patient was operated on, leaving a stable ankle with no projection. Three months later he had no pain and restarted his physical activities.

CONCLUSION

Surgical treatment of PTT dislocation by re-anchoring the flexor retinacula provides an excellent functional outcome.

[Bankart repair. Comparative study with and without suction drainage to assess shoulder pain and functional limitation]

The purpose of this study is to compare two patient cohorts with Bankart lesion, one with intraarticular drainage after surgery and another group without drainage.

MATERIAL AND METHODS

We designed a study cohort for patients with Bankart repair due to relapsing shoulder dislocation; they underwent arthroscopy and were stabilized with suture anchors; intraarticular drainage was used in one group and no drainage was used in a control patient cohort. Thirty-one consecutive patients were operated by the same team. All patients were evaluated at the office using the Rowe, Constant and UCLA scales. The statistical tests used included chi-square, the student-t test or the Wilcoxon rank sum test (nonparametric version).

RESULTS

The UCLA median value was 35 (34.5-35) in group B and 33 (32.5 -35) in group A, with p = 0.13. The Rowe test score was 100 (95;100) in group B and 100 in group A (85;100), with p = 0.913. The Constant test score was 96 (88.8-98) in group B and 96 (90.5-100) in group A with p = 0.535 and no differences.

DISCUSSION

This comparative study includes two groups that underwent arthroscopic Bankart repair, one with drainage and another one without drainage. Good results were obtained in both groups. In this study the placement of a postoperative intraarticular drainage did not improve clinical results, as no statistically significant differences were observed between both groups.

Ventricular dysfunction associated with brain trauma is cause for exclusion of young heart donors

OBJECTIVE

Ventricular dysfunction (VD) in the context of brain death (BD) is one medical cause that may be reversed to extend the range of donors for cardiac transplant programs. The aim of this study was to identify and quantify the causes for exclusion of potential heart donors and to define risk factors for VD among the BD population.

MATERIALS AND METHODS

This study of 100 heart-beating potential donors defined subjects as those younger than 50 years. We defined hemodynamic dysfunction (HD) as failure to achieve hemodynamic objectives despite the use of inotropic agents by protocol or upon diagnosing VD.

RESULTS

Among 246 BD subjects were 100 potential heart donors. Of these, 75 were transformed into real donors (RD) including 13 heart RD and 62 noncardiac RD. The conversion rate of BD subjects younger than 50 years to heart RD was 17%. When we analyzed the medical reasons for exclusion of the 62 donors who were not converted to heart RD, we observed that HD was the major cause (34%). When we analyzed the causes for exclusion related to cause of death, cranial trauma predominated (52%; P = .01; relative risk 3.5; 95% confidence interval 1.4-8.5).

CONCLUSION

Hemodynamic dysfunction represented the major cause for loss of heart donors; it was associated with younger patients with cranial trauma.

Adult stem cells applied to tissue engineering and regenerative medicine

Regeneration takes place in the body at a moment or another throughout life. Bone, cartilage, and tendons (the key components of the structure and articulation in the body) have a limited capacity for self-repair and, after traumatic injury or disease, the regenerative power of adult tissue is often insufficient. When organs or tissues are irreparably damaged, they may be replaced by an artificial device or by a donor organ. However, the number of available donor organs is considerably limited. Generation of tissue-engineered replacement organs by extracting stem cells from the patient, growing them and modifying them in clinical conditions after re-introduction in the body represents an ideal source for corrective treatment. Mesenchymal stem cells (MSCs) are the multipotential progenitors that give rise to skeletal cells, vascular smooth muscle cells, muscle (skeletal and cardiac muscle), adipocytes (fat tissue) and hematopoietic (blood)-supportive stromal cells. MSCs are found in multiple connective tissues, in adult bone marrow, skeletal muscles and fat pads. The wide representation in adult tissues may be related to the existence of a circulating blood pool or that MSCs are associated to the vascular system.