RESUMO
Recently, the work group made up of the National Transplant Organization (Organización Nacional de Trasplantes, ONT), Spanish Society of Intensive, Critical Medicine and Coronary Units (Sociedad Española de Medicina Intensiva, Crítica y de Unidades Coronarias, SEMICYUC) and other Scientific Societies have recommended using 15 mg/kg of methyl prednisolone during the management of lung donors after brain death. This recommendation is based on descriptive and retrospective studies. However, the review of different experimental and clinical studies also suggests a potential benefit of using steroids in either thoracic or abdominal organ donors during management strategies. In brain death management, early steroid administration may decrease cytokine production and also may prevent alterations induced by proinflammatoy mediators, stabilize cell membranes, reduce expression of cell surface adhesion molecules and avoid lipid peroxidation after the ischemic period. This could be beneficial in increasing number and quality of organs harvested and in decreasing rejection episodes after transplant. It would be very recommendable to carry out prospective and comparative studies to demonstrate these potential utilities. Meanwhile and knowing the deleterious effects of inflammatory activity arising during and after brain death, we recommend using 15 mg/kg of methyl prednisolone in the organ donor management, as soon as possible. The potential benefit of its immunomodulation effects, its low cost and the absence of major side effects can justify this recommendation.
Assuntos
Glucocorticoides/uso terapêutico , Doadores de Tecidos , Humanos , Transplante de Pulmão , Metilprednisolona/uso terapêutico , Cuidados Pré-OperatóriosRESUMO
La hemobilia es una entidad clinica relativamente comun que solo de manera ocasional se diagnostica en la practica medica. El presente trabajo comunica dos casos: uno de origen traumatico y otro sin este antecedente. Se revisa la literatura respecto a clasificacion, etiologia, manifestaciones, clinicas, diagnostico y tratamiento