A systematic analysis of the literature comparing postoperative recovery after propofol, isoflurane, desflurane, and sevoflurane-based anesthesia in adults demonstrated that early recovery was faster in the desflurane and sevoflurane groups. The incidence of nausea and vomiting were less frequent with propofol.
Summary:the immaturity of the fetal immune system should allow transplanted foreign tissue to be accepted, avoiding the severe toxicities associated with BMT conditioning regimens. To date, in utero bone marrow transplantation (BMT) has had limited success, largely because of poor donorMoreover, in utero BMT should be feasible before the underlying disease can produce irreversible organ damage. engraftment. The poor engraftment is probably the result of performing the procedure late in gestation This is particularly important for BMT in the leukodystrophies, since only transplants done prior to the developafter significant fetal immunocompetence has developed and/or transplanting insufficient numbers of donor ment of significant neurologic damage appear to be efficacious. 1,2 To date, however, in utero BMT has had limited hematopoietic stem cells for competing successfully with ongoing fetal hematopoiesis. To overcome these probsuccess, largely because of poor donor engraftment. 3,4 This poor engraftment may be the result of performing the prolems, we performed in utero BMT on a fetus with globoid cell leukodystrophy during the first trimester of cedure late in gestation after significant immunocompetence has developed and/or transplanting insufficient numgestation using selected paternal bone marrow stem (CD34 + ) cells. CD34 selection allowed a substantially bers of donor hematopoietic stem cells (HSC) for competing successfully with ongoing host hematopoiesis. greater number of stem cells to be transplanted.
Although the fetus died 7 weeks after the procedureWe performed in utero BMT on a fetus with globoid cell leukodystrophy early in gestation (the first trimester) using (during the 20th week of gestation), full donor engraftment was established. Moreover, the cause of selected parental bone marrow stem (CD34 + ) cells. Although the volume of marrow that can be transplanted death appeared to be overwhelming donor engraftment and leukostasis with paternal myeloid cells infiltrating into a first trimester fetus is limited, CD34 selection allowed transplantation of all the CD34 + marrow cells most tissues. The ability of in utero BMT to produce this degree of engraftment provides great promise for present in a full adult bone marrow harvest. Since CD34 is not expressed by immunocompetent T cells, this the use of this approach in the treatment of a variety of inherited disorders that can be diagnosed prenatally.approach also depleted T cells responsible for the development of graft-versus-host disease (GVHD).
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