M J Montoya

Hospital Rafael Méndez de Lorca, Lorca, Murcia, Spain

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Publications (27)43.48 Total impact

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    ABSTRACT: The attitude of health care personnel is fundamental for the procurement of organs, especially when they are based in transplant-related services. The objective of this study is to assess the attitude of hospital personnel in transplant-related services toward living kidney donation in a hospital with a cadaveric and living solid organ transplant program. A random sample was taken and stratified by type of service and job category (n = 330) in transplant-related services (procurement units, transplant units and follow-up units). The attitude toward cadaveric organ donation was evaluated using a validated psychosocial questionnaire. Student's t test, chi(2) test, and logistic regression analysis were applied for statistical analysis. The questionnaire completion rate was 94% (n = 309). Most respondents (87%, n = 268) are in favor of related living kidney donation. However, only 17% (n = 53) of respondents are in favor if this donation is unrelated. Of the rest, 4% (n = 12) of respondents would not accept a donated living kidney organ and the remaining 9% (n = 29) are undecided. Only two variables are significantly related to attitude towards living kidney donation: age (p = 0.013) and a willingness to receive a donated living organ on the part of the respondent, if a transplant organ were needed (p < 0.001). Both variables persist as significant independent variables in the logistic regression analysis. There is also a close relationship between attitude toward living kidney donation and attitude toward living liver donation (p < 0.001). The personnel in donation and transplantation units tend to have a favorable attitude towards living kidney donation making them a key element in the current promotion of living kidney donation. Moreover, the youngest workers in these units are those who tend to be more in favor, thus offering a promising future for this type of kidney donation which is becoming more of a necessity given the cadaveric organ deficit.
    Nephron Clinical Practice 01/2008; 108(1):c75-82. · 1.65 Impact Factor
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    ABSTRACT: Living liver donation is becoming a more widely accepted practice given the decrease in donor morbidity and mortality and the beneficial results in the recipient. Use of this technique is unusual in Spain. There are a number of workers against its use within the health care system. The objective of this study was to analyze attitudes toward and the variables that affect them concerning living liver donation among surgical services in a transplant hospital. A random survey was stratified by surgical area and job category in a Spanish third-level hospital with an ongoing solid organ transplant program. Attitudes toward living liver donation were assessed using a questionnaire about organ donation and transplantation that evaluated various psychosocial variables. Student's t test and the chi square test were used. A total of 263 workers were surveyed (mean age as 40 +/- 9 years). Regarding attitudes toward living liver donation, the level of acceptance was 80% (n = 211) of respondents, whereas 10% were undecided (n = 26), and another 10% were against (n = 26), assuming that the donations were related. When we asked about unrelated living donation, the percentage in favor decreased to 10% (n = 27). No differences were found with respect to job category or type of service. The variables that are related to such an attitude are the following: (1) possibility of respondent needing an organ (P = .001); (2) favorable attitude toward living kidney donation (P < .000); and (3) a belief that medical errors exist (P = .004). An important finding was that attitudes toward living liver donation were not more favorable according to whether the respondent was in favor or against cadaveric organ donation (P = .175). There was a highly favorable attitude toward living liver donation among hospital personnel in surgical services, which is an important factor to take into account if this type of donation is to be encouraged in Spain.
    Transplantation Proceedings 09/2007; 39(7):2079-82. · 0.95 Impact Factor
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    ABSTRACT: A considerable percentage of hospital personnel are against organ donation, which at a crucial time could act as an obstacle to donation. Moreover, there is often a lack of training of personnel necessary for them to provide accurate information about organ donation and transplantation. Our objective was to determine the acceptability of a training course about organ donation among hospital workers in a center with an ongoing solid organ transplant program. A random sample (n = 1168) was stratified by type of service and job category among workers in hospital services within an organ transplant program. An evaluation was made of attitudes toward donation and acceptance of a training course using a validated psychosocial questionnaire. Distribution of the survey was made by the head of each service and job category. The survey was completed anonymously and self-administered. Sixty-nine percent (n = 808) of respondents were in favor of donating their own organs. With respect to the benefit of a training course about organ donation and transplantation, 50% (n = 584) of respondents considered it to be a useful idea, whereas 15% (n = 176) did not, and 35% (n = 408) were not sure. An important finding was that 56% (n = 452) of those who are in favor of donation would take part in the course compared to only 37% (n = 132) of those who were against or undecided. There was a significant relationship between those workers who believed that the training course will be of use and the following factors: younger age (P = .000); women (P = .000); single (P = .000); nursing job category (P = .000); a temporary contract (P = .012); a worker in nonsurgical services (P = .000); prior understanding of the concept of brain death (P = .003); favoring cadaveric organ donation (P = .000); performing pro-social voluntary type activities (P = .000); discussions of organ donation and transplantation within the family (P = .022); Catholic religion (P = .001); a partner in favor of organ donation and transplantation (P = .001); and a belief that he may need a transplant (P = .000). A training course about organ donation and transplantation might be useful given that only half of the workers would be prepared to take part and with respect to the target population, only 37% of them stating that they would participate. Its main use would be to reinforce the positive attitude of those who are already in favor and increase their knowledge about the subject. What is more, if these workers received adequate training they would serve to promote donation both directly and indirectly to the general public and other hospital personnel.
    Transplantation Proceedings 07/2007; 39(5):1310-3. · 0.95 Impact Factor
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    ABSTRACT: The attitude of health-care personnel is fundamental for the procurement of transplant organs, especially in those services that are related to transplantation. The objective of this study is to find out the attitude towards living liver donation among personnel who work in transplant-related services in a hospital with a cadaveric and living organ transplant programme. A random sample was taken and stratified by type of service and job category (N=330), in services related to transplantation (procurement units, transplant units and follow-up units). Attitude was evaluated using a validated psychosocial questionnaire. Control group: a random sample of personnel in clinical services that do not have any direct contact with solid organ transplantation. Student's t-test and the chi(2) test complemented by a logistical regression analysis were applied in the statistical analysis. The questionnaire completion rate was 94% (N=309). Only 10% (N=31) of respondents are in favour of living liver donation if it is unrelated, but another 67% (N=207) are in favour if donation were for a relative. Of the rest, 11% (N=33) do not agree with living liver donation and the remaining 12% (N=38) are undecided. In the control group, attitude towards living liver donation is favourable in 82% (N=344) (P=0.0908). An analysis of the variables that influence attitude shows that the following factors are significantly related: (1) age (P=0.037); (2) a respondent's belief that he or she may need a transplant in the future (P=0.013); and (3) if it were necessary, a willingness to receive a donated living liver organ (P=0.000). Of the variables that have the most influence on attitude towards living liver donation in the bivariate analysis, there are two variables that are statistically significant in the multivariate analysis: (1) age and (2) willingness to accept a donated living liver organ from a relative if it were needed (OR=14.19). There is also a close relationship between attitude towards living liver donation and attitude towards living kidney donation (P=0.000) There is a favourable attitude towards living liver donation among personnel in units related to the transplantation and donation process, although it is less favourable than expected. Therefore, it will be necessary to increase this level of acceptance and to improve information about the matter if we want to encourage living liver donation. The youngest workers in these units are those who are most in favour, which leads us to believe that there is a hopeful future for this type of liver donation that is so necessary given the cadaveric organ deficit.
    Liver international: official journal of the International Association for the Study of the Liver 07/2007; 27(5):687-93. · 3.87 Impact Factor
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    ABSTRACT: It is important to find out about the social acceptance of xenotransplantation, especially in populations where there are pre-clinical xenotransplantation projects, and therefore the possibility of xenotransplantation to humans. In the native population of southeastern Spain this situation is well-known, but in recent years there has been an important social change because of a considerable migrational flow into Spain, especially from the British Isles. To analyze the attitude toward xenotransplantation among the population living in southeastern Spain born in the British Isles and to determine the variables that affect this attitude. A random sample was taken of British and Irish citizens resident in southeast Spain and stratified according to a respondent's nationality (n = 1700). The data were obtained between November 2005 and April 2006. Attitude was evaluated using a validated questionnaire that was completed anonymously and self-administered. The control group comprised a random sample (n = 250) of the native population. Student's t-test, the chi-squared test, Fischer's exact test and a logistic regression analysis were used in the statistical analysis. The questionnaire completion rate was 91% (n = 1546), with 69% of respondents in favor of xenotransplantation, 8% against and 23% unsure, an attitude that is similar to that of the control group (P = 0.1616). These attitudes were based on the assumption that transplanted animal organs had the same outcomes and involved the same risks as human ones. This attitude is related to the following factors: (i) being of male sex (P = 0.0477); (ii) level of education (P = 0.012); (iii) being natives from England or Wales (P = 0.016); (iv) participation in voluntary pro-social activities (P = 0.035); (v) the respondent's religion (P < 0.001); (vi) knowing that one's religion has a favorable attitude toward transplantation (P < 0.001); (vii) having discussed the subject of organ donation and transplantation within the family (P < 0.001); (viii) a partner's favorable attitude toward transplantation (P < 0.001); (ix) previous experience of donation or transplantation (P = 0.024); (x) the belief that in the future one might need a transplant (P = 0.007) and (xi) a favorable attitude toward human donation, both deceased and living (P < 0.001). In the multivariate analysis, the following are significant independent variables: sex [odds ratio (OR) = 2.206], a favorable attitude toward deceased donation (OR = 1.977), and attitude toward living donation (OR = 2.097). Attitude toward xenotransplantation among British residents who usually live in the southeast of Spain is similar to that of the native Spanish population, and is determined by many psychosocial factors, mainly related to previous attitude toward the different types of human organ donation and the respondent's sex.
    Xenotransplantation 05/2007; 14(3):255-64. · 2.57 Impact Factor
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    ABSTRACT: Many factors can cause morbidity and mortality in patients with severe acute lower gastrointestinal bleeding (LGIB). The objectives of this study are to analyze three aspects related to severe acute LGIB: (1) indications and prognostic factors for urgent surgery, (2) risk factors for morbidity and mortality, and (3) relapse rates. A retrospective cohort was collected between 1985 and 2002 in a tertiary referral center. One hundred seventy-one patients with severe acute LGIB were reviewed (LGIB is defined as frank rectal bleeding either with a hematocrit decrease >/=10 points or when a transfusion of at least three units of concentrated red blood cells is needed). The main outcome measures are: (1) indications for urgent surgery and results, (2) morbidity and mortality, and (3) relapse. There were 158 (92%) stable patients, and in 61% of these, the bleeding was identified via colonoscopy. Bleeding was identified using urgent colonoscopy in a higher percentage of patients compared to delayed colonoscopy (68% versus 14%; p < 0.001). Urgent surgery was indicated in 24 (14%) patients, and the approach was peri-anal in 5 (21%) patients and abdominal in the rest. Local intestinal resection was performed on the 15 patients in which bleeding was identified, whereas a subtotal colectomy was performed on the remaining 4 patients. The presence of hypotension (p = 0.001; 35 versus 10%) and etiology of LGIB (p < 0.001) are prognostic factors of urgent surgery. Morbidity was 6.4%, and mortality was 4.7%. The only morbidity or mortality risk factors detected were the presence of associated comorbidities (p = 0.008) and the need for urgent surgery (p = 0.002). The most frequent etiology was diverticulosis (25%). After a mean follow-up of 132 +/- 75 months, bleeding relapsed in 30% of patients. It is difficult to predict which patients are going to need urgent surgery in severe acute LGIB; only the presence of hypotension on arrival at the emergency ward would lead us to suspect a negative outcome for the hemorrhage. In severe acute LGIB, morbidity and mortality is high, and this is mainly due to the high level of associated comorbidity and the need for urgent surgery. It is necessary for strict hemodynamic monitoring of the patients at risk if we want to improve outcomes. The bleeding relapse rate is high in LGIB, although generally, it is not severe.
    Langenbeck s Archives of Surgery 04/2007; 392(2):165-71. · 1.89 Impact Factor
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    ABSTRACT: Hospital ancillary workers' opinion has credibility among the general public because they work on behalf of a hospital. The objective of this study is to analyze the attitude of ancillary employees toward living kidney donation and the variables that influence such attitude. A random sample of ancillary personnel (n=401) was taken and stratified according to type of service in a transplant hospital. Attitude was evaluated using a survey, which was completed anonymously and self-administered. The completion rate was 94% (n=377). Most (85%) are in favor of related living kidney donation, 7% against, and the 8% undecided. The multivariate analysis found that the variables with more weight affecting attitude are: 1) female sex (odds ratio [OR]=3.75); 2) a respondent's lack of concern about the possible "mutilation" of the body after donation (OR=3.65); 3) a respondent's belief in the possibility of needing a future transplant (OR=2.66); and 4) a respondent's willingness to receive a donated living kidney (OR=10.51).
    Transplantation 03/2007; 83(3):336-40. · 3.78 Impact Factor
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    ABSTRACT: IntroductionBecause of the shortage of kidney organs available for transplantation and the favorable outcomes described in living donation, this type of donation is necessity in Spain. However, living donation has yet to be developed and this may be partly because hospital personnel do not have an entirely favorable attitude toward this type of donation. The objective of this study was to analyze attitudes toward living kidney donation among health workers in services that are not usually in contact with transplantation services in a hospital with a cadaveric and living donor solid organ transplant program.
    Diálisis y Trasplante. 01/2007; 28(1).
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    ABSTRACT: Ancillary hospital personnel represent an important body of opinion because as they work in a hospital their opinion has more credibility for the general public as a result of their activity in hospitals. However, in most cases they do not have any health care training which means that their attitude could be based on a lack of knowledge or unfounded fears. The objective of this study is to analyze the attitude toward living liver donation among ancillary personnel in a hospital with a cadaveric and living liver organ transplant program and to analyze the variables that might influence such attitude. A random sample was taken which was stratified by service (n=401) among ancillary personnel in the hospital. Attitude was evaluated using a survey that was validated in our geographical area. A representative from each service was contacted. This person was given an explanation of the study and was made responsible for the distribution of the questionnaire in selected work shifts. The survey was completed anonymously and was self-administered. The c2 test, Student s t-test and logistical regression analysis were used in the statistical analysis. The questionnaire completion rate was 94% (n=377). Of all the respondents, 20% (n=74) are in favor of donating a living hemi-liver, but an additional 62% (n=233) are in favor if donation is for a relative. Of the rest, 8% (n=30) do not accept this type of donation and the remaining 11% (n=40) are unsure. The following variables are related to attitude toward living liver donation: attitude toward cadaveric donation (p=0.002); a respondent s belief that he or she might need a transplant in the future (p<0.001) and a willingness to receive a donated living liver if one were needed (p<0.001). In the multivariate analysis the following have been found to be significantly related variables: a) a respondent s belief that he or she might need a transplant in the future (OR=1.5); and b) a willingness to receive a living donated kidney if one were needed (OR=16.2). Attitude toward living liver donation is fairly favorable among ancillary personnel in a transplant hospital and is not affected by the psychosocial factors found to be related to attitude toward donation in previous studies. However, if we want to encourage this type of transplantation with living donors it will be necessary to carry out informative campaigns to raise awareness within the hospital.
    Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 12/2006; 98(12):917-28. · 1.65 Impact Factor
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    ABSTRACT: Objective We hypothesized that healthcare assistants in our hospital should have a more favorable attitude toward xenotransplantation than the general public, given their more direct contact with a preclinical xenotransplantation program. Therefore, the objective of this study was to determine the attitudes of healthcare assistants in a hospital with a preclinical xenotransplantation program and to analyze the factors that influence these attitudes.
    Diálisis y Trasplante. 10/2006; 27(4).
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    ABSTRACT: In situations of extreme urgency when there is a need for vital organs, xenotransplantation could provide a bridge until the arrival of a human organ. However, it is important to find out the level of acceptance of this potential therapy among the health care workers who would be involved in its implementation. The objective of this study is to analyze attitude among personnel in a hospital with a pre-clinical xenotransplantation program toward xenotransplantation and to determine the variables that influence this attitude. A random sample (n=1168) was taken and stratified according to job category and service. Attitude toward xenotransplantation was evaluated using a validated questionnaire. Contact was made with the head of each service who was given an explanation of the project. This person was made responsible for the distribution and collection of the survey in each service in randomly selected work shifts. Such a survey was completed anonymously and was self-administered. A random sample of 250 individuals from our regional community was used as a control group. The survey completion rate was 98% (n=1148). Most respondents are in favor (67%), 7% are against and 26% undecided. Such an attitude is more favorable in the control group (74% vs. 67%; P=0.0378). The following factors are positively related to such an attitude: (1) male sex (P<0.0005); (2) a younger age (P=0.013); (3) participation in prosocial voluntary activities (P=0.002); (4) knowing that the church has a positive attitude toward donation and transplantation (P<0.0005); (5) a partner's favorable attitude toward transplantation (P<0.0005); (6) a physician's job category (P<0.0005); (7) a resident physician's job contract situation (P=0.017); (8) a respondent's belief that he or she may need a transplant in the future (P<0.0005); and (9) a favorable attitude toward human donation, whether this be cadaveric or living (P<0.0005). In the multivariate analysis, the following persist as independent variables: (1) sex (odds ratio=1.6); (2) participation in prosocial voluntary activities (odds ratio=2.2); (3) a partner's unfavorable attitude toward transplantation (odds ratio=0.3); (4) a favorable attitude toward cadaveric donation (odds ratio=2); and (5) attitude toward living liver donation (odds ratio=3.8). Attitude toward xenotransplantation is not as favorable among hospital personnel as it is in the general public and this is determined by many factors. It will be necessary for research groups to periodically carry out awareness-raising activities about our findings in our own centers, to avoid the rejection that could be generated by a lack of awareness.
    Xenotransplantation 09/2006; 13(5):447-54. · 2.57 Impact Factor
  • Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 07/2006; 98(6):480-2. · 1.65 Impact Factor
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    ABSTRACT: To reduce the number of family organ donation refusals, it is necessary not only to act on the general public but also on the health care system. In this respect, there are data suggesting that the percentage of hospital personnel against donation is high, especially among ancillary personnel. The objective herein was to analyze the attitudes of ancillary hospital professionals toward donation of their own organs and determine factors that conditioned such attitudes. A random sample in a third-level hospital with a solid organ transplant program was stratified by ancillary services: administrative, porters, maintenance, cleaning, and cooking. Attitudes toward donation of one's own organs after death were evaluated using a questionnaire on psychosocial aspects validated in our area. It included various psychosocial variables that could affect such attitudes. The Student t test and chi-square test were used to evaluate the data. We analyzed 277 respondents of mean age 43 +/- 8 years and 96% women. The level of acceptance of organ donation was 64% (n = 178), whereas 46% were either against or undecided (n = 98). The variables which determined the attitudes were understanding of brain death (P = .004); attitude toward cadaveric manipulation, especially toward autopsy (P = .013) and cremation (P = .004); concern about mutilation after donation (P = .014); religion (P = .032); partner's attitude toward donation (P < .0001); and possibility of needing an organ in the future (P = .031). Ancillary hospital personnel had similar attitudes toward donation as those of the general public as observed in other studies. The attitudes were determined by many psychosocial factors. A campaign to raise awareness among professionals has become a priority, given that working in a hospital, their unfavorable attitude could have a strong negative impact on the general public.
    Transplantation Proceedings 05/2006; 38(3):858-62. · 0.95 Impact Factor
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    ABSTRACT: The attitudes of health care personnel, specifically doctors, have a significant influence on public attitudes toward organ donation and transplantation. The objective herein was to analyze the attitudes of Primary Care (PC) doctors toward living organ donation and to determine the psychosocial factors that condition these attitudes. A random sample was stratified by geographical location (six health areas in our community) among PC doctors, including 155 respondents from 32 health centers. Attitudes toward donation were evaluated using a psychosocial questionnaire validated in our geographical area. Contact was made with the Doctor Coordinator in each center for distribution of the questionnaires, which were completed anonymously. The chi-square test and Student t test were applied to evaluate the data. When the living donor is not related, only 21% (n = 32) of PC doctors were in favor of living kidney donation, and only 20% (n = 31) for living liver donation (P > .05). In contrast, these percentages were 90% and 89% in favor of kidney and liver related donation, respectively. Upon analysis of the psychosocial variables affecting these attitudes, there was only an association with their partner's opinion (P = .009 for kidney and P = .000 for liver), and the possibility of needing a transplant oneself (P = .000). PC doctors have favorable attitudes toward related living donation. If living donation is promoted by transplant coordination units, such PC professionals could act as a source of positive information about the matter for the general public.
    Transplantation Proceedings 05/2006; 38(3):863-5. · 0.95 Impact Factor
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    ABSTRACT: The deficit in transplantable organs is making it necessary to find alternative sources. One possibility is xenotransplantation. However, the use of animal organs may be rejected by society and among health professionals. Primary Care is fundamental for promoting matters of health; in Spain it has access to nearly 100% of the population. Our objective was to analyze the acceptance of this therapy, although it is experimental, among Primary Care professionals, given that they are the ones most involved in spreading information about this therapy if it was confirmed to be useful. A random sample was stratified by sex, job category, and geographical location among Primary Care personnel, including 428 professionals in 32 health centers among population of 2851 professionals. Attitudes toward xenotransplantation were evaluated using a questionnaire on psychosocial attitudes validated in our geographical area. Contact was made in each center with the Doctor Coordinator for doctors, the Nursing Coordinator for nurses, and an Administrative Officer for ancillary personnel. The chi-square test and Student t test were applied to evaluate categorical and continuous data, respectively. Attitudes toward xenotransplantation were similar to those obtained in human organs: favorable in 79% (n = 325), whereas 19% (n = 78) had doubts and 2% (n = 10) were against. The attitude was more favorable in men (89% vs 72%; P < .000), those who had cared for transplant patients (84% vs 71%; P = .009), those with previous experience in organ donation and transplantation (84% vs 75%; P = .033), those with an attitude in favor of cadaveric organ donation (83% vs 66%; P < .0001), and those in favor of living donation of the kidney (P < .000) or the liver (P < .000), as well as those who believed that they may need a transplant at some time in the future (84% vs 74%; P = .045). There was a clear difference in attitude according to job category (P = .018): approval rates were 89% for doctors, 76% for nurses, and 70% for ancillary personnel. Attitudes toward future application of xenotransplantation were quite positive among doctors. However, the attitudes of nursing and ancillary personnel were similar to those of the general population. The main factors related to such an attitude depended mainly on the previous relationship and attitude of the respondent toward human organ donation and transplantation.
    Transplantation Proceedings 05/2006; 38(3):853-7. · 0.95 Impact Factor
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    ABSTRACT: Lower gastrointestinal hemorrhage (LGIH) is generally self-limiting, and the most frequent etiologies are located at colonic level. The objective here is to analyze the diagnostic and therapeutic handling of acute LGIH when its etiology was located in the small intestine. Between 1975 and March 2002, 12 acute cases of LGIH originating in the small intestine were admitted to our service. All consulted the hospital with acute rectorrhage, requiring a transfusion of at least 3 units of concentrated red blood cells. The mean age was 54 +/- 21 years, 58% were women, and 83% had experienced previous episodes of LGIH. in eleven cases (92%) an urgent lower and upper endoscopy was performed without locating the source of bleeding. An arteriography was indicated in 7 patients (58%), which located the bleeding origin in 5 of them. In two cases a scintigraphy was performed, showing a Meckel's diverticulum in one patient and a normal image in another. All were operated on; in 8 cases (67%), surgery was urgent; in 9 cases, a tumor was found, and in three additional patients, a case of Meckel's diverticulum was found, with a resection being carried out for all lesions. Histology showed a leiomyoma in 7 cases, a Meckel's diverticulum in 3 cases, a leiomyoblastoma in 1, and an angioma in the remaining case. After a mean follow-up of 132 +/- 75 months, the leiomyoblastoma resulted in death, and there was a relapse in the case of angioma, which was successfully embolized with interventional radiology. Acute LGIH originating in the small intestine should be considered a possible etiology when digestive endoscopy does not locate the source of bleeding, with arteriography being a useful diagnostic technique for bleeding localization. Surgery is the definitive treatment--it confirms the etiology and rules out the presence of malignancy.
    Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 04/2006; 98(3):196-203. · 1.65 Impact Factor
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    ABSTRACT: Introduction: lower gastrointestinal hemorrhage (LGIH) is generally self-limiting, and the most frequent etiologies are located at colonic level. The objective here is to analyze the diagnostic and therapeutic handling of acute LGIH when its etiology was located in the small intestine. Patients and methods: between 1975 and March 2002, 12 acute cases of LGIH originating in the small intestine were admitted to our service. All consulted the hospital with acute rectorrhage, requiring a transfusion of at least 3 units of concentrated red blood cells. The mean age was 54 ± 21 years, 58% were women, and 83% had experienced previous episodes of LGIH. Results: in eleven cases (92%) an urgent lower and upper endoscopy was performed without locating the source of bleeding. An arteriography was indicated in 7 patients (58%), which located the bleeding origin in 5 of them. In two cases a scintigraphy was performed, showing a Meckel's diverticulum in one patient and a normal image in another. All were operated on; in 8 cases (67%), surgery was urgent; in 9 cases, a tumor was found, and in three additional patients, a case of Meckel's diverticulum was found, with a resection being carried out for all lesions. Histology showed a leiomyoma in 7 cases, a Meckel's diverticulum in 3 cases, a leiomyoblastoma in 1, and an angioma in the remaining case. After a mean follow-up of 132 ± 75 months, the leiomyoblastoma resulted in death, and there was a relapse in the case of angioma, which was successfully embolized with interventional radiology. Conclusions: acute LGIH originating in the small intestine should be considered a possible etiology when digestive endoscopy does not locate the source of bleeding, with arteriography being a useful diagnostic technique for bleeding localization. Surgery is the definitive treatment - it confirms the etiology and rules out the presence of malignancy.
    Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 03/2006; 98(3):196-203. · 1.65 Impact Factor
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    ABSTRACT: A considerable number of professionals who work in a hospital could be against organ donation, which means that when the time comes, they could act as an obstacle to donation. The objective of this study was to analyze the attitude of hospital professionals toward organ donation and to determine the factors that influence this attitude in a Spanish center with a transplant program. The study was carried out in a third-level Spanish hospital with a solid organ transplant program. A random sample was taken (n = 1262) and stratified by job category and type of service. Attitude was evaluated using a validated questionnaire. Contact was made in each service with the person responsible for each of the job categories in order to distribute the survey. The survey was completed anonymously and was self-administered. Student's t-test, the chi-squared test, and logistic regression analysis were applied in the statistical analysis. The survey completion rate was 93% (n = 1168). Most respondents were in favor of donation [69% (n = 808)]. Of those who are not in favor, 29% (n = 105) provide fear of apparent death as the reason whilst most do not give a reason (negative assertion; 57%; n = 206). There are many factors related to this attitude toward donation, which are evident in the multivariate analysis: (i) job category, in which physicians are twice as likely to be in favor of donation than ancillary personnel (OR = 2.02); (ii) a respondent's knowledge of brain death (OR = 1.64); (iii) having discussed the matter of organ donation and transplantation within the family (OR = 1.89); (iv) a preference for other options apart from burial (OR = 3.66); (v) being in favor of the performance of autopsy if it were necessary (OR = 2.76); (vi) not being concerned about mutilation of the cadaver (OR = 2); and (vii) having a partner with a favorable attitude toward donation (OR = 2.2). Attitude toward cadaveric organ donation among personnel in a transplant hospital is similar to that described in the general public and is determined by many factors. The following factors are most noteworthy: (i) job category; (ii) knowledge of the concept of brain death; (iii) consideration of the matter of donation in the family; and (iv) fear of manipulation of the cadaver. In view of this attitude, which is similar to that of the general public, it is necessary to carry out promotion activities if we want to increase cadaveric donation rates.
    Clinical Transplantation 01/2006; 20(6):743-54. · 1.63 Impact Factor
  • Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 01/2006; 98(6). · 1.65 Impact Factor
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    ABSTRACT: The search for alternative sources for transplant organs leads us to the search for animals as an inexhaustible source of organs. The objective of this study was to analyze whether livers from polytransgenic pigs expressing the human complement regulatory proteins CD55 (hDAF), CD59, and alfa alpha1,2-fucosyltransferase (H-transferase), protected against hyperacute rejection after orthotopic liver xenotransplantation to a baboon and also to study pig liver function in a nonhuman primate. Nine liver transplants from pig to baboon were divided into two groups: a control group (n = 4) of genetically unmodified pigs and an experimental group (n = 5) of pigs transgenic for CD55, CD59, and H-transferase as donors. All the donating piglets obtained through hysterectomy were maintained in specific pathogen-free conditions. The selection of transgenic pig donors followed demonstration of transgene expression using monoclonal antibodies (antiCD55, antiCD59) and immunohistological studies on liver biopsies. All animals in the control group developed hyperacute rejection with survival rates less than 16 hours without function of transplanted livers. In the experimental group none of the animals suffered hyperacute rejection. Survival in this group was between 13 and 24 hours. The livers were functional, producing bile and maintaining above 35% prothrombin activity. Only in one case was there primary dysfunction of the xenograft. Polytransgenic livers for complement regulatory proteins prevent hyperacute rejection when xenotransplanted into a baboon.
    Transplantation Proceedings 12/2005; 37(9):4103-6. · 0.95 Impact Factor

Publication Stats

274 Citations
43.48 Total Impact Points

Institutions

  • 2006–2007
    • Hospital Rafael Méndez de Lorca
      Lorca, Murcia, Spain
  • 2005–2007
    • Hospital Universitario Virgen de la Arrixaca
      • Departamento de Cirugía
      Murcia, Murcia, Spain
    • University of Murcia
      • Department of Surgery, Pediatrics and Obstetrics and Gynecology
      Murcia, Murcia, Spain