Reinfusión de sangre procedente del drenaje mediastínico en cirugía cardiaca / Autotransfunsion of shed mediastinal blood in cardiac surgery

El considerable incremento de intervenciones quirúrgicas, el desarrollo de técnicas complejas, edad media cada vez más elevada,y la mayor comorbilidad que acompaña a los pacientes intervenidos, ha motivado un mayor consumo de sangre homóloga.La cirugía cardiaca, por varios factores, fundamentalmente el empleo de la derivación cardiopulmonar o circulaciónextracorpórea, determina una utilización importante de sangre y hemoderivados. Esta situación de creciente demanda juntocon una oferta hospitalaria insuficiente a partir de las donaciones hace difícil mantener un balance adecuado entre demanday disponibilidad. En consecuencia se plantean y desarrollan diversas estrategias de ahorro de sangre en cirugía. La autotransfusiónprocedente del drenaje mediastínico, de uso habitual en algunas unidades de cirugía cardiaca, es un procedimientoaún sometido a debate con opiniones diversas y variadas en cuanto a su capacidad de ahorrar recursos sanguíneosy garantía en cuanto a problemas derivados de su uso. En el presente trabajo nos planteamos el análisis de la reinfusión postoperatoriade sangre como alternativa a la transfusión homóloga en cirugía cardiaca con los siguientes objetivos: Verificarque se trata de un método factible y de fácil aplicación, y en segundo lugar analizar y evaluar las alteraciones de la coagulación,en el paciente y en la sangre recogida, implícitas a la aplicación de esta técnica (AU)

The growing number of surgical interventions, the development of high complexity techniques, the higher comorbility and theincrease in the average age of patients, has lead to a greater spent of homologous blood. By means of many factors, especiallybecause of the cardiopulmonary bypass, undergoing cardiac surgery determines the use of an important amount ofblood and other by-products. This background of an increasing demand and an insufficient offer of blood from donations,makes it very difficult to maintain an adequate balance between demand and availability. In answer to this situation, newstrategies in blood saving are being developed. The autotransfusion of mediastinal shed blood is an usual technique in manycardiac surgery units, nevertheless there is still an ongoing debate regarding to it’s safety and capability to save blood-bankresources. In this study, we carried out the analysis of mediastinal shed blood transfusion in cardiac surgery as an alternativeto homologous blood transfusion with this aims: to verify that it is a feasible and easy to carry out method, and in secondplace, to analyze and evaluate the alterations of the coagulation in patients and in the recovered blood (AU)

Combined protocol of cell therapy for chronic spinal cord injury. Report on the electrical and functional recovery of two patients.

BACKGROUND: This is a preliminary report on successful results obtained during treatment of two patients with chronic spinal cord injury. The therapeutic approach was based on the generation of controlled inflammatory activity at the injury site that induced a microenvironment for the subsequent administration of autologous, BM-driven transdifferentiated neural stem cells (NSC). METHODS: BM mesenchymal stem cells (MSC) were cocultured with the patient's autoimmune T (AT) cells to be transdifferentiated into NSC. Forty-eight hours prior to NSC implant, patients received an i.v. infusion of 5 x 10(8) to 1 x 10(9) AT cells. NSC were infused via a feeding artery of the lesion site. Safety evaluations were performed everyday, from the day of the first infusion until 96 h after the second infusion. After treatment, patients started a Vojta and Bobath neurorehabilitation program. RESULTS: At present two patients have been treated. Patient 1 was a 19-year-old man who presented paraplegia at the eight thoracic vertebra (T8) with his sensitive level corresponding to his sixth thoracic metamere (T6). He received two AT-NSC treatments and neurorehabilitation for 6 months. At present his motor level corresponds to his first sacral metamere (S1) and his sensitive level to the fourth sacral metamere (S4). Patient 2 was a 21-year-old woman who had a lesion that extended from her third to her fifth cervical vertebrae (C3-C5). Prior to her first therapeutic cycle she had severe quadriplegia and her sensitive level corresponded to her second cervical metamere (C2). After 3 months of treatment her motor and sensitive levels reached her first and second thoracic metameres (T1-T2). No adverse events were detected in either patient. DISCUSSION: The preliminary results lead us to think that this minimally invasive approach, which has minor adverse events, is effective for the repair of chronic spinal cord lesions.