IntroductionTransfusion in trauma is often empiric or based on traditional lab tests. Viscoelastic tests such as thromboelastography (TEG®) and rotational thromboelastometry (ROTEM®) have been proposed as superior to traditional lab tests. Due to the similarities between the two tests, general opinion seems to consider them equivalent with interchangeable interpretations. However, it is not clear whether the results can be similarly interpreted. This review evaluates the comparability between TEG and ROTEM and performs a descriptive review of the parameters utilized in each test in adult trauma patients.MethodsPUBMED database was reviewed using the keywords “thromboelastography” and “compare”, between 2000 and 2011. Original studies directly comparing TEG® with ROTEM® in any area were retrieved. To verify the individual test parameter used in studies involving trauma patients, we further performed a review using the keywords “thromboelastography” and “trauma” in the PUBMED database.ResultsOnly 4 studies directly compared TEG® with ROTEM®. One in liver transplantation found that transfusion practice could differ depending on the device in use. Another in cardiac surgery concluded that all measurements are not completely interchangeable. The third article using commercially available plasma detected clinically significant differences in the results from the two devices. The fourth one was a head-to-head comparison of the technical aspects. The 24 articles reporting the use of viscoelastic tests in trauma patients, presented considerable heterogeneity.ConclusionBoth tests are potentially useful as means to rapidly diagnose coagulopathy, guide transfusion and determine outcome in trauma patients. Differences in the activators utilized in each device limit the direct comparability. Standardization and robust clinical trials comparing the two technologies are needed before these tests can be widely recommended for clinical use in trauma.

RESUMO: A remoção cirúrgica da vesícula biliar é uma operação realizada há mais de um século e nos últimos 25 anos foi objeto de inovação nos seus fundamentos técnicos, especialmente, em relação ao acesso e a exploração da via biliar principal. As indicações mais freqüentes de colecistectomia são a litíase biliar e suas complicações (colecistite aguda, coledocolitíase, colangite , pancreatite aguda biliar) e o câncer da vesícula biliar. Inicialmente, as colecistectomias para tratamento da litíase biliar eram realizadas por meio de laparotomia. No fim do século vinte, a colecistectomia passou a ser feita por meio de acessos menores como a minilaparotomia e em seguida pela videolaparoscopia, que é o acesso considerado como padrão na atualidade. Mais recentemente, a colecistectomia tem sido realizada, em caráter experimental ou excepcional, por meio do acesso transgástrico e transvaginal. Os benefícios do acesso videolaparoscópico são incontestáveis, mas o emprego desse acesso requer cautela e capacitação para minimizar a incidência de lesões traumáticas da via biliar e de outras estruturas.

Purpose:The aim of this study was to analyse the changes in transfusion requirements, in patients submitted to orthotopic liver transpantation from cadaveric donors, with the use of intraoperative red blood cell salvage (Cell Saver). Methods: Data from 41 transplants were analysed. Intraoperative blood loss was calculated from the cell salvage, suction and the swabs. The autologous and heterologous transfusions were recorded The red blood salvage was performed using the Cell Saver 5 System (Haemonetics).. For analysis the patients were divided in two groups: one that used the Cell Saver and another that didn´t. Results: The median age of the patients was 50 years and the main indication for liver transplantation was cirrhosis (35 cases -85.3%). The median blood loss was 8362 + 3994 ml (with the Cell Saver) and 10824 + 7002 ml (without the Cell Saver) and the median transfusion of heterologous packed red blood cells was 9,6 + 8 units (with the Cell Saver) compared to 22,3 + 21 units (without the Cell Saver). Conclusions: The Cells Saver has the potential to reduce the need for heterologous blood transfusion reducing the risks of transmissible diseases. Key words: Liver Transplantation. Cell Saver. Blood Transfusion. Liver Surgery. RESUMO Objetivo: O objetivo desse estudo foi analisar as mundanças na quantidade de transfusão necessária com uso doIntraoperative red blood cell salvage (Cell saver), em pacientes submetidos a transplante ortotópico de fígado, doador cadáver. Métodos: Foram avaliados dados de 41 pacientes submetidos a transplante de fígado. O sangramento foi calculado de acordo com débito do aspirador, compressas e captação do Cell saver. A reposição necessária foi avaliada de acordo com a quantidade de transfusão heteróloga e autóloga. Para análise dos dados os pacientes foram dividos em dois grupos: com e sem uso de Cell saver. Resultados: A mediana de idade foi 50 anos e principal indicação de transplante foi cirrose hepática com 35 casos (85,3%). A mediana de sangramento durante o procedimento cirúrgico 8362 + 3994 ml (com cell saver) e 10824 + 7002 ml (sem cell saver) e a mediana de transfusão de concentrado de hemácias heterólogo, durante o período de internação hospitalar 9,6 + 8 unidades (com cell saver) compar 22,3 + 21 unidades (sem cell saver). Conclusão: Uso de Cell Saver tem um potential para reduzir a quantidade de transfusão heteróloga, dimuindo o risco de transmissão de doenças.

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It is extremely important to assess psychological distress in patients listed for liver transplantation. An interdisciplinary approach is essential to improve the patients' quality of life both in the pre- and post-transplant periods.

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