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Biomedical subjects

I Penn

Publications and source records attributed to I Penn.

At least 91 records · Page 5Linked to original sources
PubMed1988

Current experience with renal transplantation in older patients.

Older patients (greater than 50 years old) are generally considered to be at high risk in renal transplantation, particularly those receiving cadaveric kidneys. The outcome in 53 older patients (mean age, 54 years; range, 50 to 64 years) receiving transplants between January 1, 1980 and December 31, 1986 and followed through June 30, 1987 were analyzed. Before 1984, immunosuppression consisted of azathioprine and prednisone (AP); thereafter, triple therapy (TT)--low-dose cyclosporine, azathioprine, and prednisone--was used. The overall 1-, 3-, and 5-year actuarial patient survival was 87%, 84%, and 84%, respectively. Survival for living related donor (LRD) transplant recipients was 100%, 92%, and 92%; survival for cadaveric (CAD) transplant recipients was 81%, 81%, and 81%. The overall graft survival was 74%, 66%, and 66% at 1, 3, and 5 years, respectively; graft survival was 88%, 81%, and 81% for LRD transplant recipients and 68%, 58%, and 58%, for CAD recipients. The patient and graft survival rates were better in the TT group than in the AP group. Eight patients died after transplantation; six within the first year. The causes of patient death were infection (50%), cardiac (25%), and malignancy (25%). Rejection (56%) and patient death (38%) accounted for most of the grafts lost. Patient and graft survival rates in diabetic patients were not significantly different from survival rates in nondiabetic patients. Results in recipients of ten secondary and one tertiary transplant were poor, with only four of 11 grafts functioning at 1 year.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Tumors of the immunocompromised patient.

Immunocompromised patients are prone to develop certain malignancies, particularly involving cells of the immune system itself (1-3). In this chapter we describe the various neoplasms, note the differences between these and similar cancers in the general population, emphasize similar tumor patterns in different types of immunodeficiency, and discuss possible etiologic factors.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Secondary neoplasms as a consequence of transplantation and cancer therapy.

A complication of various therapies is an increased incidence of cancers. We present data on 3117 types of cancer that developed in 2915 immunosuppressed organ-transplant recipients. The predominant tumors are lymphomas, skin and lip carcinomas, vulvar and perineal carcinomas, in situ uterine-cervical carcinomas, and Kaposi's sarcoma (KS). Tumors appear a relatively short time after transplantation, the earliest being KS at an average of 23 months and the latest vulvar and perineal cancers presenting an average of 98 months after transplantation. Cytotoxic drugs given to cancer patients may cause secondary neoplasms either by a direct carcinogenic effect or, indirectly, through depression of immunity. The most common secondary malignancies are leukemias, lymphomas, and bladder carcinomas. Ionizing radiation causes cancer, either by a direct carcinogenic effect on cells in the radiation field, or indirectly by depressing immunity. The most common malignancies are leukemias and bone sarcomas.

Antineoplastic Agents↗
PubMed1988

Diagnosis and management of adrenal masses: 1987 Du Pont lecture.

Adrenal enlargements were found in slightly more than 100 patients of approximately 15,000 who underwent abdominal computed tomography. A firm diagnosis was made in 61 patients. Of these, 34 were screened because of suspected metastases from nonadrenal tumours. Major causes of adrenal enlargement were metastases (20 patients), nonfunctioning adenomas (15) and hormonally active masses (9). Fine-needle aspiration biopsy was a useful diagnostic aid in patients with metastases. Surgical treatment was undertaken in 17 patients (three pheochromocytomas, one Cushing's adenoma, three Conn's adenomas, four primary carcinomas, two metastatic carcinomas, three nodular hyperplasias suspected to be part of the multiple endocrine adenopathy syndrome and one myelolipoma). Work-up of an adrenal mass includes a full history and physical examination, search for possible nonadrenal primary malignant lesions, testing for excess adrenal hormone secretion, computed tomography of the abdomen and fine-needle aspiration biopsy in selected patients.

Adrenal Gland Diseases↗
PubMed1987

Carcinoid tumor of the biliary system. Case report and literature review.

Work-up of a 62-year-old black male, with a complaint of low back pain for three months, revealed a mass in the porta hepatis, narrowing of the common hepatic duct, and dilated intrahepatic bile ducts. A 3 X 4-cm tumor in the common hepatic duct was excised and biliary continuity restored by hepaticojejunostomy. The excised mass was a carcinoid tumor with no evidence of secretory activity. The patient is well 24.5 months after treatment. The literature on carcinoid tumors of the biliary tract is reviewed.

Bile Duct Neoplasms↗
PubMed1987

Cancers following cyclosporine therapy.

Malignancies developed in 141 organ transplant recipients treated with cyclosporine. The cancers showed important differences from those seen following conventional immunosuppressive therapy (CIT). They appeared an average of 20 months after cyclosporine and 60 months after CIT. Non-Hodgkin's lymphomas (NHLs) were the most common tumors, being 41% compared with 12% in CIT patients. They appeared an average of 11 months after transplantation compared with an average of 42 months after CIT. Unlike CIT patients they more often involved lymph nodes, more frequently involved the small intestine, rarely involved the brain, and were more likely to regress after reduction of immunosuppressive therapy. Skin cancers (15% of cancers) were much less common than in CIT patients (40%). Kaposi's sarcomas were more common (8% vs. 3%). In this small series there was a surprising frequency of endocrine-related cancers and renal cell carcinomas. Only 8 patients (6%) were treated with cyclosporine exclusively. The neoplasms probably are not specific to cyclosporine therapy but appear to be a complication of immunosuppression per se.

Adult↗
PubMed1987

Neoplastic consequences of transplantation and chemotherapy.

An increased incidence of certain neoplasms occurs in immunodeficiency states. The incidence of cancer in organ transplant patients is approximately 4%. The predominant tumors are lymphomas, carcinomas of the skin and lips, carcinomas of the vulva/perineum, in situ carcinomas of the uterine cervix, and Kaposi sarcoma (KS). Tumors appear a relatively short time after transplantation. Unusual features of the lymphomas are the high incidence of non-Hodgkin lymphomas, frequent involvement of extranodal sites, and marked predilection for the brain. Skin cancers present unusual features: predominance of squamous cell carcinomas, young age of the patients, and a high incidence of multiple tumors. Cancers of the vulva/perineum occur at a younger age than in the general population and may be preceded by condyloma acuminatum or herpes genitalis. Lymphomas, leukemias, and skin cancers are increased in nontransplant patients who receive immunosuppressive therapy for nonmalignant diseases. Second tumors that develop in cancer patients, after treatment with cytotoxic therapy, are mainly leukemias, lymphomas, and bladder carcinomas.

Antineoplastic Agents↗
PubMed1986

Cancers of the anogenital region in renal transplant recipients. Analysis of 65 cases.

There is a 100-fold increase in the incidence of carcinomas of the vulva and anus in renal transplant recipients compared with the general population. Anogenital (anus, perianal skin, and external genitalia of both sexes) carcinomas occurred in 65 of 2150 renal transplant recipients who presented with 2298 different types of malignancy. Two-thirds of the patients were female and one-third male. They were much younger than persons with similar tumors in the general population. The average age of the females at the time of diagnosis was 37 years (range, 20-64) and of the males, 45 years (range, 34-62). The neoplasms occurred late after transplantation, an average of 88 months (range, 9-215), compared with an average of 56 months (range, 1-225.5) for all other post-transplant malignancies. The lesions involved the vulva, penis, scrotum, anus, or perianal area. Two patients also had involvement of the urethral meatus. In several female patients, there was a "field effect" with multiple tumors of the squamous epithelium of the anogenital area, vagina, or uterine cervix. Lesions ranged from in situ carcinomas (in one-third of the cases) to those with invasion of adjacent organs and lymph node metastases. Treatment varied from local excisions to radical vulvectomy, abdominoperineal resection, or penile resection, sometimes combined with excision of the inguinal lymph nodes. In several patients, there was a previous history either of condyloma acuminatum or herpes genitalis, suggesting a possible viral etiology of these tumors.

Adult↗