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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In 1980 we determined the patient and renal allograft survival in 299 kidney transplants recipients who, between 1976 and 1979, were randomized to splenectomy (n = 146) versus nonsplenectomy (n = 152), and who were treated with antilymphocyte globulin-azathioprine-prednisone for immunosuppression. The preliminary analysis showed significantly (P less than .05) better (10% overall, 12% for cadaver, 14% for nonidentical-related) graft survival rates at two years in splenectomized recipients. The splenectomized patients had higher white blood counts and received more azathioprine and less prednisone. We concluded that splenectomy had a beneficial effect for at least the first two years posttransplant without a detrimental effect on patient survival. Splenectomy, however, remains controversial. Thus, we reanalyzed the original cohort 7 years after the study began and 4 years after the last patient was entered. The reanalysis showed that the differences in graft survival rates between splenectomized and nonsplenectomized recipients were no longer significant. There were more late deaths from sepsis in the splenectomized group, although the overall patient survival rates were similar in splenectomized and nonsplenectomized recipients. Splenectomy modestly improved graft survival for the first few years, but the eventual fate of the graft was determined by other factors. The dominant influence on graft survival rates was the source of the kidney (at 6 years in splenectomized recipients the functional survival rate of grafts from HLA-identical siblings was 24% higher than that of grafts from HLA-mismatched relatives, which in turn was 24% higher than that of grafts from cadaver donors; in nonsplenectomized recipients the difference in 6-year function rates between HLA-identical and mismatched related grafts was 34%, and between mismatched related and cadaver grafts was 16%. Between 1979 and 1983, we performed pretransplant splenectomies in all recipients of renal allografts from HLA-mismatched related or cadaver donors. Two-year graft survival rates were 81% and 68%, respectively, in azathioprine-treated recipients, 7% and 12% higher than in the splenectomized patients in the randomized trial. (ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Long-term effect of splenectomy versus no splenectomy in renal transplant patients. Reanalysis of a randomized prospective study. 639 Aug 23

Two brothers with a PNP deficit are reported. The first case presented recurrent upper respiratory infections and died of a sepsis by pseudomonas. The second one was diagnosed when he was six months old and remains asymptomatic. Immunologic tests revealed a deficit of T cell mediated immunity. Treatment consisted on radiated erythrocytes transfusions because HLA compatible donors were not available.
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PMID:[Purine nucleoside phosphorylase deficiency. Report of two cases]. 641 Sep 51

From 1969 to 31 March 1982, 1,769 organ transplants were performed by the University of Minnesota Transplant Service. Fifty-one patients had severe osteonecrosis develop requiring 83 total joint arthroplasties. Patients with diabetes were underrepresented in the arthroplasty population; this may be due to neuropathy masking some disease. All of the patients received dramatic relief from pain and experienced improved function. Only one surgical mortality occurred--a patient with sepsis. To minimize complications, prophylactic antibiotics were used, and most patients did not undergo prophylactic anticoagulation. The most common complication was dislocation of the hip, at five to eight times the rate of those in the nontransplant arthroplasty population. These can be minimized by avoiding the posterior lateral surgical approach and by meticulous capsular repair. Despite the youth and activity of these patients, component wear was not a problem. However, because of the multicentric nature of this disease, components and surgical approach should be chosen carefully. Incidence of severe osteonecrosis was highest among cadaver kidney recipients. No HLA identical kidney recipient had severe osteonecrosis develop. Consequently, we concur with previous authors that osteonecrosis may be caused by the higher dosages of immunosuppressive agents required to prevent rejection of HLA nonidentical organs.
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PMID:Osteonecrosis in the transplant recipient. 648 89

Eight patients with aplastic anemia were transplanted with marrow from HLA-identical donors. Two patient rejected their grafts and died while 5 patients (71%) show no ill effects 3 months, 10 months, and more than 1, 2 and 4 years after the transplantation. Three of the patients who received unirradiated donor buffy coat after transplantation developed chronic graft-versus-host disease (GVHD) which, however, resolved following treatment with Prednisolone and Azathioprine. One patient with end-stage acute myeloid leukemia, who was transplanted with marrow from an identical twin, died 6 days after the transplantation of bleedings and sepsis. Eight patients with acute non-lymphoblastic leukemia (ANL) were transplanted, while in remission, with marrow from HLA-identical siblings. One patient died of interstitial pneumonia 3 months after transplantation, while another patient recovered from GVHD of the gut at 5 months after the transplantation. Seven out of 8 patients with ANL (88%) are home and well between 2 and 12 months after the transplantation.
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PMID:Bone marrow transplantation for aplastic anemia and acute leukemia at Huddinge Hospital. 675 85

A successful transurethral resection of the prostate was performed without complication in a 66-year-old man who presented with acute urinary retention, anemia, leukemia and thrombocytopenia. Preoperative treatment with red cell and platelet transfusions, HLA typing for white cell transfusions and preventative antibiotics made surgical treatment successful. With continued improvement in therapy for hematologic tumors and the improvement in survival, catheter drainage with its concomitant chance for sepsis is not a viable alternative to surgical therapy for prostatism.
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PMID:Leukemic infiltration of the prostate: a case report. 693 12

The effect of alloimmunization to white blood cells upon patients receiving granulocyte transfusions was studied. Eighteen episodes of sepsis associated with neutropenia were treated with 149 granulocyte transfusions. All products were crossmatched using a recent patient serum. Each serum was tested for granulocyte-specific antibody using the granulocyte indirect immunofluorescence test (GIIFT), and for HLA antibody, using the standard NIH lymphocytotoxicity assay. In 14 episodes of sepsis treated with 114 granulocyte transfusions, the transfusions were discontinued because there was evidence of control of infection, with and without bone marrow recovery. In this group, four per cent of all transfusions were incompatible by the GIIFT and six per cent by lymphocytotoxicity. During four episodes of sepsis treated with 35 granulocyte transfusions, blood cultures remained positive and the product was discontinued because of death. In this group, 31 per cent of all transfusions were incompatible by the GIIFT and 6 per cent by lymphocytotoxicity. The unfavorable outcome in patients with granulocyte antibodies suggests that these antibodies have an adverse effect upon the function of the transfused granulocyte.
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PMID:Response to granulocyte transfusions in the alloimmunized patient. 699 85

A woman with lymphoblastic lymphoma was treated with combination chemotherapy. She subsequently became febrile while granulocytopenic and was given unirradiated granulocyte transfusions from normal, unrelated donors. She recovered, but 12 days later noted the onset of progressive skin rash, hepatic dysfunction, diarrhea and pancytopenia and, 22 days after her last granulocyte transfusion, died of gram negative septicemia. Histologic examination of multiple tissues including the skin, liver, and intestinal tract showed changes characteristic of acute graft-versus-hose disease (GVHD). Y-chromatin analysis of the patient's peripheral blood just before death indicated the presence of male cells. HLA typing of lymphocytes and skin fibroblasts from the patient and lymphocytes from the family and granulocyte donors was also consistent with engraftment of cells from one of the male granulocyte donors. This donor most likely was homozygous for one of the patient's halotypes, perhaps facilitating engraftment of his cells and subsequent development of transfusion-induced acute GVHD. Until more precise guidelines can be established, we recommend that all cellular blood products given to patients receiving intensive chemotherapy be irradiated with 1500 rad.
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PMID:Fatal graft-versus-host disease in a patient with lymphoblastic leukemia following normal granulocyte transfusion. 700 36

Six personal observations of aseptic acute arthritis with positive serology for yersinia pseudotuberculosis (YPT) have been related, the specific serodiagnosis was clearly positive (greater than 1/500) for all the patients and the rate variations of repeated examinations were constantly observed. These cases have been compared with 14 sporadic observations of the existing studies where such reactive arthritis were referred to a recent YPT infection, this confrontation leads us to specify the characteristics of this inflammatory rheumatism : starting by a prearthritic phase with variable combination of fever, diarrhea, abdominal pains, erythema nodosum, usually polyarticular affection (90%) mostly of the knees (89%), ankle-joints, wrists and elbows, marked inflammatory clinical and biological signs but without X. Rays abnormalities. The course which seems hastened by anti-inflammatory medication ends up several weeks or months later without recurrences or secondary diseases by a recovery. The presence of HLA B27 antigen in 50% out of the 10 tested cases enables us to discover the intervention of a predisposing genetic factor. A semiologic and nosologic comparison is established with polyarthritis of YEC infection. The discussion concerning the 18 observations where only serology based diagnosis exists, turns mainly on the reality of sporadic YPT rheumatism. If it is not yet possible to assert with certitude the authenticity of such YPT reactive arthritis there is several arguments in support of that, particularly the existence of post-septicemia aseptic polyarthritis and the existence of similar joint-affection during the far-east scarlatiniform fever which is a special form of YPT infection.
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PMID:[Aseptic arthritis with positive serology for Yersinia pseudotuberculosis. Apropos of 6 new cases]. 702 61

Platelet concentrates from HLA-compatible donors frequently provide satisfactory posttransfusion platelet responses in patients who, for immunologic reasons, are refractory to pooled random-donor platelet transfusions. The use of donors who have HLA antigens "crossreactive" with those of the recipient has increased the number of donors available for individual patients. Occasionally, successful transfusions occur with donors mismatched for HLA. Immunologic explanations include a restricted pattern of HLA antibody production and a variable expression of HLA antigens on the platelet surface. Immunologic reasons for poor response to HLA-matched transfusions include ABO incompatibility, antibodies directed against platelet-specific antigens. HLA-Bw4/Bw6 incompatibility, and as yet undefined incompatibilites. The one-hour posttransfusion platelet count may be useful in identifying patients who are alloimmunized and have non-immunologic reasons for shortened platelet survival such as fever, sepsis, or a coagulopathy. Caution must be used in evaluating results of currently available platelet crossmatch tests.
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PMID:Transfusion strategy: use of HLA-matched platelet transfusions for alloimmunized patients. 722 58

Bare lymphocyte syndrome (BLS) is a rare disorder characterized by deficient expression of human leukocyte antigens (HLA antigens) and combined immunodeficiency to various degrees. Recurrent severe infections especially due to opportunistic organisms are common. Here, we present two patients with BLS who lack both class I and II antigens (Type III). They had the typical clinical and immunologic findings of BLS. The first patient showed marked improvement in pulmonary symptoms resulting from cytomegalovirus infection by means of gancyclovir treatment. However, intramuscular injections of interferon-alpha (IFN-alpha) had no beneficial effect in either the expression of HLA antigens or the clinical status. The second patient died of septicemia while being prepared for bone marrow transplantation.
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PMID:Bare lymphocyte syndrome with lack of HLA class I and II antigens. Presentation of two cases. 759 64


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