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J Lappin

Publications and source records attributed to J Lappin.

8 recordsLinked to original sources
PubMed2005

Successful conversion to rapamycin for calcineurin inhibitor-related neurotoxicity following liver transplantation.

INTRODUCTION: Neurotoxicity is a well-recognized side effect of calcineurin inhibitors. Rapamycin is considered to be significantly less neurotoxic than calcineurin inhibitors (CNIs). The aim of this study was to retrospectively analyze a group of post-liver transplant patients who had been converted to rapamycin because of CNI-related neurotoxicity. PATIENTS AND METHODS: Orthotopic liver transplantation (OLT) was performed in 56 consecutive patients between April 1, 2003, and August 15, 2004. Immunosuppression was administered with tacrolimus, mycophenolic acid, and corticosteroids. RESULTS: Seven patients were converted to rapamycin due to new-onset neurotoxicity or exacerbation of previous neurological symptoms secondary to CNI. None of the patients had toxic levels tacrolimus (>15 ng/mL) at the time of symptoms, which persisted despite reduction of CNI dose. The indications for conversion were: (1) peripheral neuropathy; (2) seizure; (3) metabolic encephalopathy; and (4) central pontine myelinolysis. All patients showed improvement or resolution of their neurological symptoms after conversion to rapamycin. Two patients died, the first due to a hypoxic event and the second due to central pontine myelinolysis with limited improvement and a family decision to withdraw care. There were no complications directly attributed to rapamycin. Specifically, there were no thrombotic events, wound complications, or biliary leaks. Three patients had a rejection episode that was successfully treated with pulse corticosteroids and low-dose tacrolimus (levels < 5 ng/mL). CONCLUSIONS: Rapamycin can be safely used in OLT recipients with severe neurological symptoms ascribed to or exacerbated by CNIs. Rapamycin monotherapy may be inadequate to control rejection early after transplantation. Rapamycin can be combined with low doses of CNI to prevent rejection.

Adrenal Cortex Hormones↗
PubMed1994

Total parenteral nutrition, bacterial translocation, and host immune function.

Total parenteral nutrition (TPN) is associated with increased infectious complications in trauma and perioperative patients compared with enteral nutrition support. This study evaluated the effects of TPN on splenocyte and peritoneal macrophage (PM phi) function and intestinal bacterial translocation. Male Wistar rats underwent central vein cannulation and were randomized to isocaloric feeding of a regular chow diet (RD) plus saline infusion or TPN for 7 days. Splenocytes and PM phi were harvested to assess concanavalin A mitogenesis, superoxide production, and Candida albicans phagocytosis. Bacteria-positive mesenteric lymph nodes (MLNs) were found in 77% (10 of 13) of TPN-fed rats compared with 17% (2 of 12) of RD-fed rats (p < 0.05). Splenocyte mitogenesis, PM phi superoxide production, and C. albicans phagocytosis were significantly decreased in the TPN group compared with results in the RD group. In a second study, rats received RD, TPN, and parenteral nutrition (PN) with 10% or 20% of calories given as oral chow (PN and 10% chow and PN and 20% chow) for 7 days. PN and 10% chow reversed the TPN-induced suppression of C. albicans phagocytosis. PN + 20% chow significantly increased splenocyte mitogenesis, PM phi superoxide production, and C. albicans phagocytosis and killing to normal levels and was associated with a decreased incidence of bacteria-positive MLN. Thus, administration of TPN is associated with impaired PM phi microbicidal and splenocyte proliferative function. These defective cellular functions were reversed with a small amount of oral feeding.

Animals↗
PubMed1994

Impairment of pulmonary macrophage function with total parenteral nutrition.

OBJECTIVE: The effects of total parenteral nutrition (TPN) administration on pulmonary macrophage function and host response to gram-negative pulmonary infection were evaluated. SUMMARY BACKGROUND DATA: Administration of TPN resulted in increased infectious complications in traumatized and perioperative patients, but underlying mechanisms are unclear. METHODS: Twenty-six male Wistar rats underwent central vein cannulation and were randomized to isocaloric feeding of a regular chow diet (RD) plus saline infusion or TPN without chow diet for 7 days. Pulmonary alveolar macrophage (PAM phi) superoxide production, Candida albicans phagocytosis and killing, and tumor necrosis factor (TNF) production in response to endotoxin (LPS) were assessed. Mesenteric lymph nodes (MLN) were cultured. A second group of rats (n = 6/group) were inoculated intratracheally with a sublethal dose of 9 x 10(9) live Escherichia coli per animal, and the lungs were cultured quantitatively 72 hours later to assess bacterial clearance. Finally, 11 RD-fed rats and 13 TPN-fed rats received intratracheal inoculation of 1.4 x 10(10) live E. coli and were included in follow-up. RESULTS: Administration of TPN was associated with a significant increase in bacteria positive MLN compared with those in the RD group (p < 0.01). Pulmonary alveolar macrophage superoxide production, Candida albicans phagocytosis and killing, TNF production, and pulmonary clearance of bacteria were decreased significantly in TPN-fed rats compared with those fed a regular chow diet (p < 0.05). These pulmonary macrophage function changes were associated with a significantly higher mortality in TPN-fed rats compared with RD-fed rats after higher dose pulmonary E. coli inoculation. CONCLUSIONS: Defective host pulmonary antimicrobial immune responses during TPN are associated with intestinal bacterial translocation, and may explain increased infectious complications.

Animals↗
PubMed1992

Splenic pseudocyst: aspiration or cyst decapsulation.

A 12 year old boy with a splenic pseudocyst is reported. Percutaneous drainage resulted in complete emptying but rapid reaccumulation. Cyst decapsulation with splenic preservation was curative and is recommended for definitive therapy of splenic pseudocysts.

Child↗
PubMedDate not supplied

Early results with restorative proctocolectomy.

The first 25 restorative proctocolectomies (RP) performed by one surgeon since 1986 are reviewed. Ulcerative colitis (23) and idiopathic megarectum (2) were the indications for surgery. The initial seven patients had a submucosal proctectomy and transanal hand sewn pouch-anal anastomosis. Eighteen patients had a totally stapled RP. One patient with malignancy died from factors unrelated to surgery. Complications developed in eight patients after pouch-anal anastomosis and in four patients after ileostomy closure. There was one pouch failure due to pelvic sepsis. No pelvic sepsis has occurred following a stapled ileal pouch-anal anastomosis with defunctioning ileostomy. After a mean follow up period of 20.5 months all patients are continent (mean stool frequency = 4/day and 0.5/night). Soiling occurred in three patients who had a transanal hand sewn pouch-anal anastomosis. All patients in the stapled group have satisfactory control. Restorative proctocolectomy produces satisfactory operative and functional results which have improved as our experience has increased.

Adolescent↗