RESUMO
BACKGROUND: To better understand the role of acute normovolemic hemodilution (ANH) in a surgical setting with high risk of bleeding, we analyzed all randomized controlled trials (RCTs) in the setting of cardiac surgery that compared ANH with standard intraoperative care. The aim was to assess the incidence of ANH-related number of allogeneic red blood cell units (RBCu) transfused. Secondary outcomes included the rate of allogeneic blood transfusion and estimated total blood loss. METHODS: Twenty-nine RCTs for a total of 2439 patients (1252 patients in the ANH group and 1187 in the control group) were included in our meta-analysis using PubMed/MEDLINE, Cochrane Controlled Trials Register, and EMBASE. RESULTS: Patients in the ANH group received fewer allogeneic RBCu transfusions (mean difference = -0.79; 95% confidence interval [CI], -1.25 to -0.34; P = .001; I = 95.1%). Patients in the ANH group were overall transfused less with allogeneic blood when compared with controls (356/845 [42.1%] in the ANH group versus 491/876 [56.1%] in controls; risk ratio = 0.74; 95% CI, 0.62 to 0.87; P < .0001; I = 72.5%), and they experienced less postoperative blood loss (388 mL in ANH versus 450 mL in control; mean difference = -0.64; 95% CI, -0.97 to -0.31; P < .0001; I = 91.8%). CONCLUSIONS: ANH reduces the number of allogeneic RBCu transfused in the cardiac surgery setting together with a reduction in the rate of patients transfused with allogeneic blood and with a reduction of bleeding.
Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/tendências , Transfusão de Eritrócitos/tendências , Hemodiluição/tendências , Hemorragia Pós-Operatória/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Procedimentos Cirúrgicos Cardíacos/métodos , Transfusão de Eritrócitos/métodos , Hemodiluição/métodos , Humanos , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Transplante Homólogo/métodos , Transplante Homólogo/tendênciasRESUMO
Solid organ transplantation has become a clinical practice after the development of different immunosuppressive drugs that allowed controlling rejection. The price to be paid for that is the permanent risk of infections and malignancies and a significant drug-associated toxicity. The establishment of transplant tolerance has been the "holy grail" for transplantation medicine since its beginnings. Different experimental approaches and clinical trials resulted in the accumulation of knowledge on mechanisms and strategies that favor the establishment of tolerance without achieving the objective of autonomous allograft tolerance in the clinical field. Development of tolerance in intestinal transplantation constitutes a challenging situation due to several particular features that contribute to the generation of a strong allogeneic response. In the present review, we summarize the different immune mechanisms that may contribute to allograft tolerance. The different barriers that should be bypassed in intestinal transplantation to tolerate the graft are discussed. Finally, we revise the strategies that were applied with different degrees of success in the clinical field including the most promising recent approaches and the forthcoming candidates in the field that might be translated into clinical trials in the near future.
Assuntos
Intestinos/transplante , Imunologia de Transplantes/imunologia , Tolerância ao Transplante/imunologia , Rejeição de Enxerto/imunologia , Doença Enxerto-Hospedeiro/imunologia , Humanos , Modelos Imunológicos , Transplante Homólogo/tendênciasRESUMO
O objetivo deste artigo é discutir e esclarecer algumas das controvérsias relacionadas ao uso do osso alógeno seco-congelado (DFDBA - Demineralized Freeze-Dried Bone Allograft) na Odontologia. Indicaçöes e vantagens desse material também säo apresentadas. Apesar de existirem opiniöes contrárias ao seu uso, esse enxerto é considerado seguro para o uso em humanos e vários estudos mostraram-no ser um material eficaz na terapia regenerativa
Assuntos
Ossos Faciais/fisiopatologia , Ossos Faciais/transplante , Transplante Homólogo/reabilitação , Transplante Homólogo/tendências , Experimentação HumanaRESUMO
A falta de doadores de orgaos e um fator critico que limita o emprego do transplante ortotopico de figado em nosso meio. O "split-liver" refere-se a seccao regrada do figado de um doador para implante em dois receptores. Os autores revisaram a literatura e observaram que apesar desta tecnica possuir indices de complicacoes pos-operatorias e mortalidade superiores ao transplante habitual constitui-se em boa opcao tecnica para pacientes cronicamente em listas de espera bem como aqueles com insuficiencia hepatica aguda e subaguda que necessitam de um novo orgao para manterem-se vivos.