Transfus Apher Sci
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Apheresis is used as therapeutic approach to improve outcome of patients with severe sepsis, septic shock and multi organ dysfunction syndrome. The concept is to reduce the extent of toxins and cytokines as well as other activators of the various cascade systems. In addition the replacement of plasma, in some of the protocols, helps to substitute with substances that are consumed/complex bound by the inflammatory reactions during the severe clinical condition. This article reviews literature in the field of adsorption technologies as well as plasma exchange techniques.
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Massive transfusion is a consequence of uncontrolled bleeding. It taxes the resources of both hospital and physicians. It occurs most commonly in trauma, cardiac and vascular surgery and less frequently in obstetrics. ⋯ The protocol was developed with the input from transfusion medicine, trauma surgery, emergency and ICU and anaesthesia. The protocol is distributed with the 7th unit of blood issued and is a reminder of the principles. Results are tracked and may lead to modifications in the protocol.
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Children and adolescents comprise a significant proportion of the hemophilia population, including those patients who have developed inhibitors to factor VIII or FIX. We examine the use of rFVIIa for the treatment of bleeding episodes and the prevention of bleeding in children and adolescents with hemophilia A and B with inhibitors, focusing on registry data and recent clinical trial results. Based on this review of the literature, we conclude that recombinant FVIIa is safe and effective for use in controlling bleeding in these patient populations.
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Hodgkin Lymphoma (HL) has become one of the most curable cancers, even in adulthood, through continuous improvement of therapeutic options and their verification by large multicenter trials. Today more than 95% of patients with HL in early stages and in advanced stages 85-90% can be cured. Nevertheless, these good results are threatened by treatment associated toxicities such as infertility, cardiopulmonary toxicity and secondary malignancies. ⋯ N Engl J Med 2003; 348: 2386-95] to improve the efficacy of COPP/ABVD by time- and dose-intensification, omission of Velban and Dacarbazin and adding Etoposide resulting in the BEACOPP principle. From the initial pilot studies in 1992 three trial generations, HD9, HD12, HD15, have now established this principle as one of the most effective chemotherapy regimen in advanced HL. We certainly hope that it will not last another 20 years to establish the BEACOPP regimen as an attractive curative treatment option for at least the high risk cohorts of HL.