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 myelodysplastic syndromes are composed of a group of clonal hematologic neoplasms, the course of which is complicated by ineffective hematopoiesis or leukemic transformation (or both). Therapeutic results may have been misleading in the past. Most patients have been managed with supportive measures, such as transfusions of erythrocytes, administration of antibiotics, and transfusions of platelets during active bleeding episodes. These supportive measures have prolonged and improved the quality of life of patients with myelodysplastic syndromes. Vitamin supplementation (folate, vitamin B12, and pyridoxine) has seldom been rewarding. Differentiation agents such as cis-retinoic acid and 1,25-dihydroxyvitamin D3 have been of benefit in only a limited number of patients. Androgens have not been useful, although danazol, which is an attenuated androgen, has been effective in a subset of patients with the presence of cell-bound platelet antibodies. Low-dose cytarabine, which has been studied extensively because of its differentiating activity in vitro, is associated with a generally low rate of complete remission and substantial toxicity. Antileukemic therapy is generally useful in young patients with rapidly progressive disease. Several hematopoietic growth factors are currently being evaluated in clinical trials; their use in combination or in conjunction with chemotherapy may be opening new horizons for these patients. With improvements in the prevention and treatment of graft-versus-host disease, allogeneic transplantation is a viable option for patients younger than 55 years of age who have severe cytopenias.
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PMID:Management of patients with myelodysplastic syndromes. 203 Jun 15

Over the last several years, internal reservoir type urinary diversions have become popular. We have already performed Kock continent ileal reservoir for urinary diversion in more than 80 patients. The experience with the Kock pouch prompted us to try a new form of continent urinary reservoir originally reported by Indiana University group. The Indiana pouch is a composite structure using ileum and cecum. The antireflux mechanism is provided with tunneled ureteral implantation along the tenia of the cecum. Plication of the terminal ileal segment along with the ileocecal valve maintains urinary continence. The tubular configuration of the cecum is completely disrupted with either an ileal patch or Heineke-Mikulicz re-configuration to construct a low pressure reservoir. Between October, 1987 and September, 1988, we performed Indiana continent urinary diversion in 15 cases: 13 males and 2 females, from 47 to 73 years old (mean age 61.3 years), 14 bladder cancer patients and 1 bladder sarcoma patient. The initial 8 patients underwent Heineke-Mikulicz type operation and the subsequent 7 patients ileal patch-type operation. Median followup has been 7 months. There were no major early complications but one postoperative death with blood transfusion related graft versus host disease (GVHD). The late complication occurred in 2 patients: 1 stenosis of the pouch due to insufficient detubularization of the cecum and 1 pyelonephritis required no admission. Serum electrolytes and vitamin B12 remained normal in all patients. Patients perform self-catheterization every 3-5 hours during the day and 0-2 times at night for volumes ranging up to 800 ml. With regard to volume capacity and pressure characteristics, the ileal patch type reservoir seemed to be superior to the Heineke-Mikulicz type pouch as a receptacle for urine. Over-all, 12 of 14 patients (86 per cent) have acceptable continence. The remaining 2 patients have significant daytime leakage requiring pads or a cutaneous bag. Followup examination with excretory urography showed no upper tract obstruction and X-rays of the pouch showed no reflux. Indiana pouch is a relatively simple continent urinary reservoir, since the steps of this technique already are familiar to urologists. It may be an alternative form of continent urinary diversion.
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PMID:[Indiana continent urinary reservoir: report of 15 cases]. 280 78

The B12 absorption test (Schilling test) with intrinsic factor was used to examine ileal B12 absorption in 26 patients after allogeneic transplantation. The test was well tolerated and showed a profound fall in B12 absorption, which was maximal at two weeks after transplantation and recovered by eight weeks. The predominant influence on absorption at this stage was probably the conditioning schedule, and the presence of acute graft versus host disease (GVHD) was not associated with a further impairment of absorption. Six patients with chronic GVHD were studied. When compared with nine patients without GVHD there was a significant (p less than 0.005) reduction of B12 absorption. These findings suggest that the B12 absorption test may be a useful non-invasive method of studying bowel function after bone marrow transplantation.
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PMID:Vitamin B12 absorption after allogeneic bone marrow transplantation. 332 53

Pseudo-scleroderma should not be confused with true scleroderma, the prognosis of which is unpredictable and often serious. Progressive acrosclerosis must be differentiated from Raynaud's disease, congenital or hereditary disorders of unknown aetiology: Werner's syndrome, acrogeria and progeria; Rothmund-Thomson's syndrome, Steinert's disease, phenylketonuria, disorders of glycogen metabolism; metabolic disorders: mutilating acropathies, scleromyxoedema, porphyria cutanea tarda; occupational and iatrogenic disorders: acroosteolysis, toxic epidermic syndrome (Spain), scleroderma-like change induced by bleomycin, chronic graft-versus-host disease; and leprosy. Acute diffuse scleroderma should not be confused with Buschke's scleroedema, sclerema neonatorum, systemic amyloidosis and scleroderma-like changes in hypothyroidism. Linear pseudo-scleroderma is suggested by the following scleroderma-like conditions: facial hemiatrophy, acrodermatitis atrophicans, melorheostosis, pseudo-scleroderma after corticosteroid injection, and cutaneous lesions in carcinoid syndrome. Scleroderma in plaque must be differentiated from hypodermitis sclerotisans, panatrophy and localized lipoatrophies, hypodermitis after vitamin K injection, basal cell carcinoma, necrobiosis lipoidica, vitiligo, chronic radiodermatitis, cutaneous lymphatic invasion. Scleroderma-like changes after drug injection (vitamin B12, progestin), anetoderma barely resemble morphea guttata.
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PMID:[Pseudoscleroderma and sclerodermiform states]. 624 36

Brief virologic news included the discovery of the virophage, a unique parasite of the giant mimivirus and the association of HHV-8 infection with a peculiar form of African diabetes. Secondly, this news focused on risk factors for arterial or venous thrombosis and therapy for auto-immune disorders. Only oral estrogen therapy increases the risk of venous thromboembolism in postmenopausal women. Despite significant homocysteine lowering, vitamin supplementation with folic acid, vitamins B6 and B12 did not reduce total cardiovascular events among high-risk patients. Patients with venous thromboembolism have a substantially increased long-term risk of subsequent cardiovascular events while obesity, systemic arterial hypertension, and diabetes are common risk factors for arterial and venous thrombosis. The non fasting ApoB/ApoA1 ratio was superior to any of the cholesterol ratios for estimation of the risk of acute myocardial infection in all ethnic groups. Preventive anticoagulation of in-patients with risk of venous thromboembolism was inadequately prescribed in many hospitals of the world. Subcutaneous administration of methotrexate was more effective than the oral administration at the same dosage in patients suffering from active rheumatoid arthritis. Hydroxychloroquine directly reduces the binding of antiphospholipid antibody-beta2-glycoprotein I complexes to phospholipid bilayers. Anti-IL-5 and anti-IL-6 antibodies were effective for the treatment of respectively hypereosinophilic syndrome and rheumatoid arthritis. The efficacy of proteasome inhibitors and mesenchymal stems cells have been demonstrated in respectively two mouse strains with lupus-like disease and steroid-resistant severe acute graft-versus-host disease. These treatments may be useful for auto-immune disorders if their long term toxicity is acceptable. In conclusion, subcutaneous injections of physiological saline, used as placebo in two different trials, enhanced in vitro activation of immunocompetent cells in healthy individuals.
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PMID:[What's new in internal medicine?]. 1926 9

An important complication of allo-SCT is GVHD, which commonly affects the skin, liver and digestive tract. Clinical symptoms of GVHD of the digestive tract (GVHD-DT) include excessive diarrhoea, abdominal pain and cramps, nausea and vomiting, gastrointestinal bleeding, dysphagia, and weight loss. Treatment is complicated and regarding nutritional support, only a few guidelines are available. Our aim was to critically appraise the literature on nutritional assessment, nutritional status and nutritional support for patients with GVHD-DT. Evidence shows that GVHD-DT is often associated with malnutrition, protein losing enteropathy, magnesium derangements, and deficiencies of zinc, vitamin B12 and vitamin D. Limited evidence exists on derangements of magnesium, resting energy expenditure, bone mineral density and pancreatic function, and some beneficial effects of n-3 polyunsaturated fatty acids and pancreatic enzyme replacement therapy. Expert opinions recommend adequate amounts of energy, at least 1.5 g protein/kg body weight, supplied by total parenteral nutrition in cases of severe diarrhoea. When diarrhoea is <500 mL a day, a stepwise oral upgrade diet can be followed. No studies exist on probiotics, prebiotics, dietary fibre and immunonutrition in GVHD-DT patients. Future research should focus on absorption capacity, vitamin and mineral status, and nutritional support strategies.
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PMID:Nutritional support in patients with GVHD of the digestive tract: state of the art. 2277 21