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Biomedical subjects

I Penn

Publications and source records attributed to I Penn.

At least 109 records · Page 6Linked to original sources
PubMed1986

Development and incidence of cancer following cyclosporine therapy.

Eighty-seven organ transplant recipients developed 88 tumors after immunosuppression with CsA. The neoplasms showed important differences from those seen following conventional immunosuppressive therapy (CIT). Malignancies appeared an average of 14 months (range, 1 to 82) after CsA and 59 months (range, 1.0 to 225.5) after CIT. Cancers were particularly common among recipients of extrarenal organs. NHLs were the most common neoplasms comprising 52%, compared with 12% in CIT patients. They appeared an average of 8.5 months after transplantation, compared with an average of 41 months after CIT. Unlike NHLs in CIT patients, they more often involved lymph nodes, were more widespread, more frequently involved the small intestine, rarely involved the brain, were more likely to regress, and had a better prognosis following reduction of immunosuppressive therapy. Skin cancers (13% of cancers) were less common than in CIT patients (40%). Kaposi's sarcomas were more common (10% v 3%). Some tumors commonly seen after CIT, including in situ uterine cervical carcinomas and carcinomas of the vulva/perineum, have not occurred in CsA patients. In this small series, there was a surprising frequency of endocrine-related malignancies (ovarian, testicular, breast, and thyroid) and renal cell carcinomas. Longer follow-up and study of larger numbers of patients will determine whether differences from CIT patients will persist. Only seven (8%) patients were treated only with CsA, the remainder received other immunosuppressive agents, mainly prednisone. The malignancies probably are not specific to CsA therapy but appear to be a complication of immunosuppression per se.

Adult↗
PubMed1986

Cancer is a complication of severe immunosuppression.

Diverse states of immunodeficiency are complicated by the development of various types of cancer. Most striking in nearly every type of immunodeficiency is a high incidence of a neoplasm of the immune system itself, the NHL, which consists of activated pathologic lymphocytes. Morphologically, these are mostly reticulum cell sarcomas, arise from B-cells, tend to be extranodal in distribution, have a predilection for the brain and are probably caused by EBV. If Kaposi's sarcoma is a form of lymphoreticular malignant disease, as some investigators think, the situation becomes even more intriguing. We need to intensively study the various groups of immunosuppressed patients, including those with and without tumors, to seek clues to the cause of neoplasms. Such information may shed light on the causes of similar malignant conditions that occur in the general population and on the role of the immune system in the control of cancer. Hopefully, such knowledge may lead to immunologic methods for the prevention and cure of neoplasms.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Proteinuria following transplantation. Correlation with histopathology and outcome.

A review of 693 renal transplant recipients revealed 77 (11%) in whom persistent, heavy proteinuria (greater than 2 g/24 hr) developed. Renal histology was available in all 77 patients. Twenty-one patients had received kidneys from living-related donors, the remaining 56 from cadaveric donors. The cause of proteinuria in these 77 patients was as follows: transplant glomerulopathy (30), allograft glomerulonephritis (22), chronic rejection (21), renal vein thrombosis (2), diabetic glomerulosclerosis (1), and hypertensive nephrosclerosis (1). Of the 22 patients who developed glomerulonephritis in the transplanted kidney, 6 had recurrent disease (3--membranous glomerulopathy, 2--focal sclerosis and hyalinosis, 1--membranoproliferative glomerulonephritis); 6 developed de novo glomerulonephritis; and in 10 the type of glomerulonephritis could not be classified as recurrent or as de novo because of lack of characterization of the original kidney disease. Renal vein thrombosis occurred in association with other lesions in an additional 5 cases (3--chronic rejection; 2--membranous glomerulopathy). In follow-up only 23.4% (18 of 77) of the patients maintained prolonged graft function; the majority of grafts being lost within one year of the development of persistent, heavy proteinuria. Of the 18 patients who retained their grafts, 8 had glomerulonephritis, 5 transplant glomerulopathy, and 5 chronic rejection. This study confirms the poor prognosis that has been reported with the development of nephrotic-range proteinuria in renal allograft recipients.

Graft Survival↗
PubMed1984

Air embolism after central venous catheterization.

Air embolism--the most dangerous complication of central venous catheterization--may occur in several ways. The most frequent is from disconnection of the catheter from the related intravenous tubing. An embolism may present with a sucking sound, tachypnea, air hunger, wheezing, hypotension and a "mill wheel" murmur. A later manifestation is severe pulmonary edema. In a review of 24 patients, the mortality was 50 per cent. Among the survivors, five (42 per cent) had neurologic damage. Immediate treatment includes placing the patient in the left lateral and Trendelenberg positions, administration of oxygen and aspiration of air from the heart. Cardiac massage and emergency cardiopulmonary bypass may be necessary. Most instances can be prevented by inserting the cannula with the patient in the Trendelenberg position, occluding the cannula hub except briefly while the catheter is inserted, fixation of the catheter hub to its connections and occlusive dressing over the track after removal of the catheter.

Adult↗
PubMed1983

Psychiatric aspects of hepatic transplantation.

We conducted formal psychiatric evaluations and extensive chart reviews in a series of 34 patients surviving an average of 5 1/4 years after hepatic transplantation. Seven of 14 children and 19 of 20 adults exhibited obvious psychiatric disturbances before the operation. (There was not time to evaluate another 5 children and a sixth was an infant; one adult arrived in hepatic coma.) All patients experienced psychiatric problems postoperatively. Organic brain syndromes and apprehensiveness were the most common preoperative problems in pediatric patients, and problems in relationships with family members, anxiety, regression, and helplessness were most common after surgery. In adults, organic brain syndromes, anxiety, and depression were the most common preoperative and postoperative problems. While psychosocial disturbances in liver transplant recipients were similar in many respects to those of the more well-studied kidney homograft patients, a number of important differences emerged: organic brain syndromes, fear of death, severe regression (psychological functioning appropriate to a younger age), worries that a suitable donor would not be found in time, and insomnia were more common, and concerns about the origin of the homograft and about changes in body image were relatively rare postoperatively. These differences seem to be related to the severity of liver disease requiring transplantation, the effects of the illness on the brain, the lack of an alternative means of life support resulting in greater prominence of concerns about survival, the exclusive use of cadaver rather than living donors, and the greater effect of the illness than of its treatment on physical appearance.

Adolescent↗
PubMed1983

Inflammatory polyposis in an ileal blind loop.

A case of inflammatory polyposis of the ileum after ileosigmoid anastomosis is reported. Two features are noteworthy. First, the polyps were localized in a blind ileal loop. Second, while rare ileal inflammatory polyps related to enteroenteric anastomosis have been reported, to our knowledge this is the first instance of approximately 50 polyps to be described at such a site. The etiology of these lesions is unknown but may be related to fecal irritation, stasis, bacterial overgrowth, or bacterial toxin. These polyps may ulcerate and bleed, causing iron deficiency anemia, and they must be distinguished from neoplastic polyps. Since side-to-side and end-to-side anastomoses have become more common with use of the surgical stapler, inflammatory polyps may be encountered more frequently.

Aged↗
PubMed1982

Jejunal rupture caused by a Sengstaken-Blakemore tube.

In a patient with cirrhosis and bleeding esophageal varices who had previously undergone a partial gastric resection, the gastric balloon of a Sengstaken-Blakemore tube was inadvertently placed into the efferent jejunal limb of the gastrojejunostomy. Inflation of the balloon to the standard volume of 150 ml resulted in rupture of the jejunum. Precautions in the use of the Sengstaken-Blakemore tube that might prevent this complication are described.

Esophageal and Gastric Varices↗
PubMed1982

Second neoplasms following radiotherapy or chemotherapy for cancer.

While radiotherapy and antineoplastic chemotherapy often control malignancies they may, paradoxically, cause new cancers to develop as long-term complications. Although almost any type of neoplasm can occur, radiation-induced malignancies are most likely to affect the myelopoietic tissues and the thyroid gland. The former tissues are also most frequently involved by chemotherapy. The combination of intensive radiotherapy and intensive chemotherapy is particularly leukemogenic. Acute myeloid leukemia has occurred with increased frequency following treatment of Hodgkin's disease, non-Hodgkin's lymphoma, multiple myeloma, ovarian cancer, polycythemia vera, carcinoma of the thyroid gland, and carcinoma of the breast. Radiation-induced malignancies usually occur in the field of irradiation. For example, radiotherapy for carcinoma of the cervix may be followed by the development of carcinomas of the endometrium, vagina, urinary bladder, colon , rectum, and anus, as well as mesotheliomas of the peritoneum and osteosarcomas of the pelvis. Tumors developing in an irradiated field include a substantial number of soft tissue sarcomas or osteosarcomas. There is a 20-fold increase of second cancers following treatment of childhood malignancies, mostly sarcomas of bone and soft tissues, but including leukemia, and carcinomas of the thyroid gland, skin, and breast. The latent period between radiotherapy and the appearance of a second cancer ranges from 2 years to several decades, often being 10-15 years. With chemotherapy the mean latent period is shorter, approximately 4 years. The mechanism of oncogenesis by radiotherapy or chemotherapy is poorly understood and probably involves a complex interplay of somatic mutation, co-oncogenic effects, depression of host immunity, stimulation of cellular proliferation, and genetic susceptibility. The danger of developing second malignancies following radiotherapy or chemotherapy emphasizes the need for lifelong follow-up of patients given these forms of treatment; particularly in those with a long life expectancy as are those treated for childhood neoplasms.

Drug-Related Side Effects and Adverse Reactions↗
PubMed1981

Immunosuppression and the development of malignancies of the upper airway and related structures.

In the general population, 90% of the malignancies developing in the upper respiratory tract are squamous cell carcinomas. Analysis of 1081 neoplasms in 1023 renal transplant patients reported to the Denver Transplant Tumor Registry indicates that squamous cell carcinoma remains the predominant malignancy which develops in the upper respiratory tract of immunosuppressed individuals. Comparing the incidence of cancers of the oral cavity (excluding lip cancers) in the immunosuppressed population with the general population it is rather similar (3.5% vs. 4%). When lip cancers are included, one sees a great excess of tumors developing in transplant patients (15% vs. 4.6%). Thus the excess of head an neck epithelial malignancies among these patients is confined to neoplasms of the lip. Examination of the 25 patients reported in this study reveals an unusually young age of the patients, the average age being 41.8 years compared with the general population where most head an neck tumors occur in the 55-65 age group. The average time post-transplantation when cancer developed was 5.3 years, supporting the concept that the more effective the immunosuppressive regimen for prevention of graft rejection, the greater the susceptibility for the development of cancer. Since 90% of transplant patients have serological or clinical evidence of active herpes virus infection, it is possible that this microorganism may play a role in the development of certain head and neck malignancies, especially those involving the lips.

Adult↗