Recommendations on the use of recombinant activated factor VII as an adjunctive treatment for massive bleeding – a European perspective

INTRODUCTION: Our aim was to develop consensus guidelines for use of recombinant activated factor VII (rFVIIa) in massive hemorrhage. METHODS: A guidelines committee derived the recommendations using clinical trial and case series data identified through searches of available databases. Guidelines were graded on a scale of A to E (with A being the highest) according to the strength of evidence available. Consensus was sought among the committee members for each recommendation. RESULTS: A recommendation for the use of rFVIIa in blunt trauma was made (grade B). rFVIIa might also be beneficial in post-partum hemorrhage (grade E), uncontrolled bleeding in surgical patients (grade E), and bleeding after cardiac surgery (grade D). rFVIIa could not be recommended for use in the following: in penetrating trauma (grade B); prophylactically in elective surgery (grade A) or liver surgery (grade B); or in bleeding episodes in patients with Child–Pugh A cirrhosis (grade B). Efficacy of rFVIIa was considered uncertain in bleeding episodes in patients with Child–Pugh B and C cirrhosis (grade C). Monitoring of rFVIIa efficacy should be performed visually and by assessment of transfusion requirements (grade E), while thromboembolic adverse events are a cause for concern. rFVIIa should not be administered to patients considered unsalvageable by the treating medical team. CONCLUSION: There is a rationale for using rFVIIa to treat massive bleeding in certain indications, but only adjunctively to the surgical control of bleeding once conventional therapies have failed. Lack of data from randomized, controlled clinical trials, and possible publication bias of the case series data, limits the strength of the recommendations that can be made

Correction: Management of bleeding following major trauma: a European guideline

SCOPUS: er.jinfo:eu-repo/semantics/publishe

Management of bleeding following major trauma: an updated European guideline

INTRODUCTION: Evidence-based recommendations are needed to guide the acute management of the bleeding trauma patient, which when implemented may improve patient outcomes. METHODS: The multidisciplinary Task Force for Advanced Bleeding Care in Trauma was formed in 2005 with the aim of developing a guideline for the management of bleeding following severe injury. This document presents an updated version of the guideline published by the group in 2007. Recommendations were formulated using a nominal group process, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence and based on a systematic review of published literature. RESULTS: Key changes encompassed in this version of the guideline include new recommendations on coagulation support and monitoring and the appropriate use of local haemostatic measures, tourniquets, calcium and desmopressin in the bleeding trauma patient. The remaining recommendations have been reevaluated and graded based on literature published since the last edition of the guideline. Consideration was also given to changes in clinical practice that have taken place during this time period as a result of both new evidence and changes in the general availability of relevant agents and technologies. CONCLUSIONS: This guideline provides an evidence-based multidisciplinary approach to the management of critically injured bleeding trauma patients

Vampires in the village Žrnovo on the island of Korčula: following an archival document from the 18th century

Središnja tema rada usmjerena je na raščlambu spisa pohranjenog u Državnom arhivu u Mlecima (fond: Capi del Consiglio de’ Dieci: Lettere di Rettori e di altre cariche) koji se odnosi na događaj iz 1748. godine u korčulanskom selu Žrnovo, kada su mještani – vjerujući da su se pojavili vampiri – oskvrnuli nekoliko mjesnih grobova. U radu se podrobno iznose osnovni podaci iz spisa te rečeni događaj analizira u širem društvenom kontekstu i prate se lokalna vjerovanja.The main interest of this essay is the analysis of the document from the State Archive in Venice (file: Capi del Consiglio de’ Dieci: Lettere di Rettori e di altre cariche) which is connected with the episode from 1748 when the inhabitants of the village Žrnove on the island of Korčula in Croatia opened tombs on the local cemetery in the fear of the vampires treating. This essay try to show some social circumstances connected with this event as well as a local vernacular tradition concerning superstitions

Du coprome infantile

Thèse : Médecine : Université de Bordeaux : 1898N° d'ordre : 11

Place de l'aprotinine au cours des transplantations hépatiques (indications, contre-indications, limites)

La transfusion sanguine utilisée lors des transplantations hépatiques (THO) est responsable d'effets délétères sur le pronostic des patients opérés d'une THO et la survie des greffons. L'administration prophylactique d'aprotinine permet de réduire à la fois les pertes sanguines, les besoins transfusionnels et enfin les variations hémodynamiques survenant lors des THO. Cependant, certaines données décrites dans la littérature pourraient limiter l'usage de l'aprotinine : Des découvertes cliniques, biologiques, échographiques et nécropsiques chez les patients atteints d'hépatopathie chronique ou subissant une THO suggèrent l'existence d'un état pro-thrombotique. L'inhibition de la fibrinolyse associée à l'aprotinine pourrait exposer ces patients à un risque thrombotique accru. D'autre part, l'usage de l'aprotinine ne modifie en rien le pronostic postopératoire des patients opérés d'une THO. Les besoins transfusionnels médians sont estimés entre 2 à 5 culots globulaires au cours des THO, limitant ainsi l'intérêt de l'administration prophylactique systématique d'aprotinine dans cette indicationThe adverse influence of blood transfusion on patient outcome and graft survival is suspected in orthopedic liver transplantation. With this respect, prophylactic aprotinin administration decreases blood loss, transfusion requirements, and the hemodynamic changes associated with graft reperfusion in patients undergoing orthopedic liver transplantation (OLT). However, data indicate limiting the use of aprotinin in OLT : a) Clinical, biological, echocardiographic, and post-mortem findings recorded in patients with chronic liver disease or undergoing OLT suggest that a continuous prothrombotic state exists in these patients. Whether the inhibition of fibrinolysis associated with aprotinin therapy will expose some patients to untoward thrombosis is questionnable. b) Aprotinin did not appear to alter postoperative outcome in patients undergoing OLT. c) Aprotinin decreases blood transfusion requirements only when surgery is associated with significant blood loss. However, at the present time, median transfusion requirements of 2 to 5 red blood cell units are recorded in OLT. Implication : prophylactic aprotinin administration to all OLT patients is not warranted. The decision to use aprotinin in OLT should be taken on individual basisPARIS12-CRETEIL BU Médecine (940282101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Gestion agricole de l'eau a la parcelle et systemes de culture irrigues dans la zone caraibe

National audienc