Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018133 (graft-versus-host disease)
 18,032 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The aim of the study was to evaluate the indications of colonoscopy, diagnostic accuracy and efficacy treatment of procedure in young patients aged less than eighteen years using standard forward colonoscopes Olympus CF LB2, CF LBw and CF HL20. Among 5,400 procedures done along eleven years, 112 (2.07 per 100) were performed in patients aged less than eighteen years, 37.6 per 100 of which were performed in children under ten years. In this group general anaesthesia was employed without complications. The most frequent indication of colonoscopy in young patients was rectal bleeding (62.5 per 100). Related to the frequency, in this series, the control of graft versus host disease in patients submitted to bone marrow transplantation was the second indication (11 per 100), followed by the study of chronic anaemia (4.2 per 100) and control of the chronic inflammatory bowel disease (4.2 per 100). Diagnostic accuracy reached 93.75 per 100. In 6 per 100 of the cases the exploration were considered unsatisfactory because inadequate cleaning of the colon. The most frequent diagnostic was "normal colon" (29.6 per 100 of the cases). Polyp was found in 21.2 per 100 of the cases. Polypectomy was performed in all indicated cases. One patient with multiple polyposis were submitted to surgery. Colonoscopy reached the right colon in 25.4 per 100 of the cases. In 54 per 100 of the procedures reached splenic angle and in 83.8 per 100 of the cases, all sigmoid colon was explored. From this experience we suggests that colonoscopy, using standard endoscopes, is a very useful diagnostic and therapeutic technique in child and in young people.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Fiber colonoscopy in children under 18. Our experience with 112 patients studied in the digestive endoscopy section of a general hospital]. 207 60

Transplantation of allogeneic peripheral blood progenitor cells (PBPCs) may have advantages over bone marrow transplantation (BMT) with regards to the speed of hematopoietic and immunologic recovery, which may then shorten the time spent in hospital and decrease costs. The recipient might also profit by an enhanced graft-versus-leukemia reaction exerted by the high number of natural killer cells contained in such grafts. The donor could be spared the discomfort and risks of general anesthesia and marrow harvesting. Primary transplantation of unmanipulated allogeneic PBPCs has not been reported so far because the vast amount of T cells contained in the collection product was thought to cause severe graft-versus-host disease. We present preliminary data on primary transplantation of allogeneic PBPCs in patients who either suffered from advanced leukemia or had a donor unable to undergo general anesthesia. Eight patients with a median age of 42 years suffering from acute myelogenous leukemia (AML) in first remission (n = 3), AML in third remission, AML in relapse (n = 2), acute lymphoblastic leukemia in second remission, or chronic myelogenous leukemia in accelerated phase received myeloablative therapy followed by transplantation of unmanipulated allogeneic PBPCs mobilized with granulocyte colony-stimulating factor (5 to 10 micrograms/kg of body weight of filgrastim administered for 5 to 6 days) in their HLA-identical donors. Hematopoietic reconstitution was achieved in all patients with a median of 15.5 (16.5) days after transplant needed to surpass an absolute neutrophil count of 0.5 (1.0) x 10(9)/L. The median time to an unsupported platelet count greater than 20 (> 50) x 10(9)/L was 19.5 (41) days after grafting. Three patients did not exhibit signs of acute graft-versus-host disease (GVHD), grade I disease was seen in one patient, and three patients experienced grade II disease limited to the skin. The only patient with severe acute GVHD (grade III) refused to take his oral cyclosporin regularly and had ineffective serum levels for most of the time until relapse. Six of eight patients are currently alive without evidence of disease between 61 and 533 days after grafting; two patients grafted for AML in relapse achieved a complete remission after transplantation but relapsed again and died of leukemia on days +48 and +70, respectively. Primary transplantation of unmanipulated allogeneic PBPCs is feasible and results in long-term engraftment without causing detrimental GVHD.
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PMID:Primary transplantation of allogeneic peripheral blood progenitor cells mobilized by filgrastim (granulocyte colony-stimulating factor) 760 19

There is a growing interest in the use of peripheral blood stem cells (PBSC) for allogeneic transplantation. This is due in part to the idea that, as with autologous transplantation, increasing the number of allogeneic hemopoietic progenitors infused may lead to reduced complications. However, introducing the PBSC technique into allogeneic transplants implies theoretical as well as ethical problems involving both patient and donor. We are still uncertain whether the PBSC technique will result in an increase of GVHD or (better) of GVL. G-CSF, necessary for effective PBSC mobilization, is safe but its use in normal subjects should be regarded with caution. For this reason, a Study Committee promoted by the GITMO (Gruppo Italiano Trapianto di Midollo Osseo) evaluated the key aspects of allogeneic PBSC collection and transplantation. The present paper summarizes the scientific data and suggests some guidelines for the introduction of allogeneic PBSC transplantation into clinical practice. The procedure should be considered experimental and the Committee strongly recommends the use of allogeneic PBSC in experienced centers, initially in patients with advanced disease. The donor should be given a complete explanation of the advantages and risks of G-CSF therapy, leukapheresis and general anesthesia. A careful monitoring of both patient and donor should also be included to watch for short-term and long-term side effects.
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PMID:Allogeneic transplants of rhG-CSF-mobilized peripheral blood stem cells (PBSC) from normal donors. GITMO. Gruppo Italiano Trapianto di Midollo Osseo. 753 68

Interest in umbilical cord blood as an alternative source of hematopoietic stem cells is growing rapidly. Umbilical cord blood offers the clinician a source of hematopoietic stem cells that are readily available and rarely contaminated by latent viruses. Moreover, the collection of umbilical cord blood poses no risk to the donor; there is no need for general anesthesia or blood replacement, and the procedure causes no discomfort. Whether cord blood lymphocytes are as likely to cause GVHD as lymphocytes from older individuals is unknown. Current clinical experience would suggest that the incidence may be low. Few of the patients who have thus far received umbilical cord blood, including recipients of HLA-disparate grafts, have developed clinically significant GVHD. These results and associated laboratory findings pose intriguing possibilities for the future of umbilical cord blood stem cells in the setting of unrelated-donor transplantation. With the marked incidence of Grade 2 to 4 acute GVHD that is currently observed after unrelated-donor bone marrow transplantation, a reduction in incidence or severity would be a major advance in this field. In the setting of autologous marrow transplantation, there are other intriguing possibilities; for example, cord blood may be an optimal source of pluripotential stem cells for use in gene therapy. As detailed in Broxmeyer's review, the large-scale collection and storage of cord blood stem cells is no longer just a concept; it has become a reality. Pilot programs for the banking of unrelated-donor umbilical cord blood have already begun in the United States and Europe.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Umbilical cord blood transplantation. 860 20

The increase of non specific surgeries in transplanted patients may be related to the better survival achieved by the efficacy of immunosuppressive therapy and improved surgical and intensive care conditions. Therefore, the anaesthetist may be mandated to give anaesthesia in such patients, treated in hospitals which are not involved in transplantation procedures. The ignorance of the main physiologic and pharmacological changes in the new grafted organ as well as the knowledge of high risks of rejection or infection contribute to the anxiety often encountered in front of these patients. The denervated heart is unable to respond to stimulations requiring the integrity of autonomic neural mechanisms. Modulation of cardiac output depends on intrinsic activity (Frank-Starling mechanism) and therefore of end diastolic volume (preload). The denervated transplanted lung shows inability to elicit cough reflex; the latter is totally abolished in case of tracheal anastomosis. These physiologic changes have no deleterious effects on early cardiac and pulmonary functions following transplantation. In the same way, renal, liver or pancreatic functions are restored after respective replacement. However chronic rejection occurs frequently in 50% of patients in a mean time of 5 years following surgery except for liver transplanted patients which seem to be better protected. It results in a progressive decrease in organ function tests. The preoperative assessment requires primary contact with the transplant center. This communication should give precious information about the last biological and functional results as well as about the immunosuppressive therapy. Standard preoperative investigations include measurements of haemoglobin, urea, electrolyte and creatinine concentrations, liver tests, ECG, chest X-ray and coagulation pattern. Previsible difficult intubation should be detected in case of previous pancreas transplantation. Immunosuppressive therapy and other treatments should not be disrupted until surgery. Usual premedication may be used. Previsional peroperative transfusion requires specific packed red blood cells, fresh frozen plasma and platelets in order to reduce CMV contamination and GVH reactions. Locoregional or general anaesthesia may be used with respect to usual contraindications. Special attention should be given in cardiac transplanted patients in order to maintain adequate preload. As atropine is ineffective, bradycardia may be treated by isoprenaline. Patients with lung transplants require a reduction of vascular loading and of hydratation and early postoperative pulmonary physiotherapy. Pancreas transplanted patients often suffer from severe cardiac diseases (coronaropathy). The immunosuppressive therapy modifies the pharmacological behavior of many anaesthetic agents. Ciclosporine enhances mainly the effects of muscle relaxants. Peroperative invasive monitoring requires full aseptic techniques. Invasive monitoring should be discussed in terms of benefit-risk ratio.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Anesthesia for non-specific surgery in a post-transplantation patient]. 833 62

Hepatic dysfunction is common in patients who receive intensive chemotherapy and it is important to determine the etiology in order to institute appropriate therapy. The role of laparoscopic liver biopsy in patients with neutropenia, thrombocytopenia, or both was evaluated as a mean of making treatment decisions and as a determinant of clinical outcome. Laparoscopic liver biopsy was performed in 29 subjects who were receiving intensive cytotoxic therapy with or without bone marrow transplantation. One to three direct-vision laparoscopic liver biopsies were performed in each patient using a Tru-cut needle during general anesthesia. Platelet concentrate transfusions were usually given before, during, and immediately after biopsy. Bleeding was controlled with spatula electrocautery. Thirty-two biopsies were obtained in 29 patients. At the time of liver biopsy, white blood cell and platelet counts ranged from 0 to 14,300/microliters (median: 2500/microliters), and 1000 to 47,000/microliters (median: 20,000/microliters), respectively. Bleeding at the liver biopsy site was readily controlled during the procedure without clinical evidence of significant bleeding; no procedure-related complications were noted and no patients required re-exploration. All biopsies were informative and the lesions observed in 32 biopsies revealed graft-versus-host disease (n = 5), hepatic candidiasis (n =1), hepatic veno-occlusive disease (n = 3), cholestasis (n = 19), hemosiderosis (n = 26), toxic injury (n = 8), hepatic steatosis (n = 4), granuloma (n = 1), viral infection (n =1), and malignancy (n = 1). Laparoscopic liver biopsy has been proven to be an effective means of assessing the cause of liver dysfunction in patients who were thrombocytopenic and immunosuppressed. The diagnosis obtained at laparoscopic liver biopsy altered therapy in nine of 29 (31%) patients.
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PMID:Laparoscopic liver biopsy to evaluate hepatic dysfunction in patients with hematologic malignancies: a useful tool to effect changes in management. 872 71

Allogeneic peripheral blood stem cell transplantation (allo-PBSCT) has been increasingly used as an alternative to allogeneic bone marrow transplantation (allo-BMT). In comparison with allo-BMT, preliminary results indicate that rapid hematopoietic engraftment can be obtained, and there is no increase in the incidence and severity of acute GVHD after allo-PBSCT. Furthermore, general anesthesia is not required to collect a sufficient number of PBSCT, which are usually mobilized by G-CSF administration. Therefore, allo-BMT will be replaced by allo-PBSCT in near future.
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PMID:[Allogeneic peripheral blood stem cell transplantation]. 897 90

Interest in umbilical cord blood as an alternate source of hematopoietic stem cells is growing rapidly. Umbilical cord blood offers the clinician a source of hematopoietic stem cells that is rarely contaminated by latent viruses and is readily available. Moreover, the collection of umbilical cord blood poses no risk to the donor; there is no need for general anesthesia or blood replacement, and the procedure causes no discomfort. Whether cord blood lymphocytes are as likely to cause GVHD as lymphocytes from older individuals is unknown. Current clinical experience would suggest that the incidence may be low. Few of the patients transplanted with umbilical cord blood thus far have developed clinically significant GVHD, including recipients of HLA-disparate grafts. These results and associated laboratory findings pose intriguing possibilities for the future of umbilical cord blood stem cells in the setting of unrelated transplantation. With the marked incidence of grade 2-4 acute GVHD that is currently observed after unrelated bone marrow transplantation, a reduction in incidence or severity would be a major advancement in this field. In the setting of autologous trans-plantation, there are other intriguing possibilities; for example, cord blood may be an optimal source of pluripotential stem cells for gene therapy. The large-scale collection and storage of cord blood stem cells has become a reality. Pilot programs for the banking of unrelated umbilical cord blood have already begun in the United States and Europe. Not only is there the potential for reducing the time from search initiation to the time of donor stem cell acquisition but also there is the potential for reducing the risks associated with unrelated bone marrow transplantation. There is also the hope of remedying the shortage of donors from ethnic and racial backgrounds that are currently underrepresented in most unrelated donor programs. Even with the creation of such banks, it should not be forgotten that the collection of umbilical cord bloods should at least be considered when a child with leukemia, lymphoma, neuroblastoma, marrow failure syndrome, immunodeficiency state, or inborn error of metabolism has a mother who is pregnant. The clinical results to date in small recipients would suggest that it is at least as good as bone marrow; but additional patients and more time will be needed to finalize this conclusion.
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PMID:Allogeneic umbilical cord blood transplantation. 907 4

Hematopoietic progenitor cells are present in umbilical cord blood; placental blood (PB) previously considered as waste product now constitutes an alternative source of hematopoietic stem cells for bone marrow reconstitution. This has promoted the establishment of cord blood banks for use in unrelated transplants. The banking of PB offers many advantages: the donors do not require anesthesia, stored PB can be a valuable source of stem cells for patients from ethnic minorities underrepresented in volunteer registers, and stored PB can be made available much faster than bone marrow from unrelated donors. Preliminary clinical experience suggests that, due to the immunological immaturity of PB cells, graft versus host disease might be lower than when using bone marrow from adult donors and HLA restrictions might be less stringent. If the number of nucleated cells in PB often appears low for patients weighing more than 40 kg, clinical data suggest that the number of stem cells may be sufficient for adult transplantation. The number of cord blood banks throughout the world is increasing rapidly. In the USA and Europe, more than 10,500 PB units are stored and available for transplantation. In the next 5 years, a total of 50,000 PB will be reached which may be sufficient to provide for the majority of candidates for unrelated BM transplantation. The practices of umbilical cord blood collection, mother selection, infectious disease screening, cell manipulation and storage must be standardized. Some accreditation process should be mandatory for assessing operating procedures and the quality assurance programs of the banks, and for allowing the international exchange of placental blood between transplant centers.
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PMID:[Cord blood banks--unrelated transplants]. 957 80

A 70-yr-old woman was scheduled for hepatectomy and colectomy. We gave general anesthesia with N2O-O2-Isoflurane and continuous epidural block. About 4.5 hours after the start of the operation, 8 units of irradiated RBC-MAP were transfused. Then elevated T waves were noted and serum potassium was increased to 5.4 mmol.l-1. The transfusion of RBC-MAP was stopped and calcium gluconate was administered immediately. Then serum potassium decreased to 4.3 mmol.l-1 and ECG returned to normal. During the operation, 10 units of irradiated RBC-MAP were transfused and 8 units of them had been stored more than 1 week after the irradiation. We suspect that hyperkalemia was induced by high concentration of potassium in RBC-MAP. Irradiation of blood products is an effective way to prevent post-transfusion graft versus host disease. However, the increase in potassium is greater in the irradiated than nonirradiated RBC-MAP. We must pay attention to the high concentration of potassium in th eplasma of RBC-MAP stored after irradiation.
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PMID:[Hyperkalemia after irradiated blood transfusion]. 1008 32


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