Preventing opioid prescription after major surgery: a scoping review of opioid-free analgesia.

Background: Excessive opioid prescribing after surgery has been recognised as a contributor to the current crisis of opioid addiction and overdose. Clinicians may potentially tackle this crisis by using opioid-free postoperative analgesia; however, the scientific literature addressing this approach is sparse and heterogeneous, thereby limiting robust conclusions. A scoping review was conducted to systematically map the extent, range, and nature of the literature addressing postoperative opioid-free analgesia.

[Latex allergy: accidental diagnosis after urological procedure. Case report].

Background And Objectives: Allergy to natural rubber latex products has become a major source of concern, affecting both patients and healthcare workers. This report aimed at describing an accidental diagnosis of latex allergy after urological surgery under spinal anesthesia when patient presented clinical manifestations of anaphylactic shock.

Case Report: Male patient, 16 years old, with posterior urethra lesion who had been managed for the last 3 years with chronic indwelling latex urethral catheter due to two previous unsuccessful attempts to restore urinary drainage.

The conservative physiology of the immune system.

Current immunological opinion disdains the necessity to define global interconnections between lymphocytes and regards natural autoantibodies and autoreactive T cells as intrinsically pathogenic. Immunological theories address the recognition of foreignness by independent clones of lymphocytes, not the relations among lymphocytes or between lymphocytes and the organism. However, although extremely variable in cellular/molecular composition, the immune system preserves as invariant a set of essential relations among its components and constantly enacts contacts with the organism of which it is a component.

Stabilization of serum antibody responses triggered by initial mucosal contact with the antigen independently of oral tolerance induction.

Initial contacts with a T-dependent antigen by mucosal routes may result in oral tolerance, defined as the inhibition of specific antibody formation after subsequent parenteral immunizations with the same antigen. We describe here an additional and permanent consequence of these initial contacts, namely, the blockade of secondary-type responsiveness to subsequent parenteral contacts with the antigen. When repeatedly boosted ip with small doses (3 microg) of ovalbumin (OVA) (or lysozyme), primed B6D2F1 mice showed progressively higher antibody responses.

Aging and immunoglobulin isotype patterns in oral tolerance.

In the present review we address oral tolerance as an important biological phenomenon and discuss how it is affected by aging. Other factors such as frequency of feeding and previous digestion of the antigen also seem to influence the establishment of oral tolerance. We also analyze immunoglobulin isotypes of specific antibodies formed by tolerant and immunized animals of different ages submitted to different conditions of oral antigen administration.

Immaturity, ageing and oral tolerance.

Founding studies of cellular immunology emphasized that tolerance to allografts could only be achieved early in the embryonic or neonatal period, suggesting that the establishment of self-tolerance, a main event in the organization of the immune system, would necessarily take place in immature hosts. Contradicting these ideas, oral tolerance is a common, daily phenomenon, easily achieved by a physiological route in adult immunocompetent animals. Furthermore, there is solid evidence that, after the neonatal period, the susceptibility to oral tolerance induction also wanes and that it may be restored by adoptive transfer of cells from young hosts.

Indirect effects of oral tolerance cannot be ascribed to bystander suppression.

The addition of tolerated antigens to immunizing doses of unrelated antigens blocks antibody responses to these unrelated antigens. This inhibition, which the authors have called the indirect effects of tolerated antigens, occurs even when the mixture of proteins is injected as soon as 24 h after the oral tolerance induction. The indirect effects also do not require the simultaneous injection of the two proteins: they are still present 72 h after an injection of Ova in Ova tolerant mice, but do not occur if the unrelated protein is injected 24 h before the tolerated protein.

Indirect effects of oral tolerance in mice.

Anti-DNP antibody formation resulting from intraperitoneal (i.p.) immunization with DNP-KLH may be blocked by simultaneous (i.

Systemic immunization of mature mice by the oral route.

1. Mice of several strains which are susceptible to the induction of oral tolerance by a single gavage with 20 mg of ovalbumin (Ova) when young adults (7-8 weeks old) become less susceptible or refractory to tolerance induction when mature (20-40 weeks old). The antibody-forming capacity of these mature animals remains invariant compared to young adults (8-10 weeks old).

Influence of age on the induction of oral tolerance in mice and its adoptive transfer by spleen cells.

1. Seven-week-old B6D2F1 mice were highly susceptible to the induction of oral tolerance to ovalbumin (Ova), whereas 70-week-old mice were totally refractory. 2.