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Biomedical subjects

J S Thompson

Publications and source records attributed to J S Thompson.

At least 91 records · Page 5Linked to original sources
PubMed1996

Effect of epidural analgesia on postoperative ileus after ileal pouch-anal anastomosis.

Epidural analgesia has been reported to enhance gastrointestinal motility and shorten postoperative ileus. Postoperative ileus can be influenced by many factors, including the operative procedure. Our aim was to evaluate the effect of supplemental epidural anesthesia and postoperative analgesia on ileus after ileal pouch-anal anastomosis (IPAA). This was a retrospective review of 50 consecutive nonrandomized patients undergoing IPAA over a 10 year period by a single surgeon. 27 patients received general anesthesia and parenteral analgesia. 23 patients received supplemental epidural anesthesia and analgesia. The two groups were comparable with respect to age, sex, diagnosis, and American Society of Anaesthesiology status. Operative time, blood loss, and transfusion requirements were also similar, but massive (>1,000 mL) blood loss was more frequent in the general group (37% vs 13%, P < .05). Twelve (44%) patients in the general group and seven (30%) in the epidural group had complications (NS). Mean duration of nasogastric suction, tube reinsertion, and interval to taking liquid and regular diets was similar in the two groups. Mean pain scores for the first 24 hours were significantly lower in the epidural group (1.9 +/- 1.0 vs 2.5 +/- 0.6, P < 0.05). Supplemental epidural anesthesia and analgesia does not shorten clinical postoperative ileus after a complex colorectal procedure (IPAA).

Adolescent↗
PubMed1996

Allogeneic bone marrow transplantation with T cell-depleted partially matched related donors for advanced acute lymphoblastic leukemia in children and adults: a comparative matched cohort study.

Allogeneic BMT provides the best treatment currently available for long-term disease-free survival in patients with recurrent ALL. Historically, partially matched related donors provided the opportunity for treatment to a greater number of patients than matched related donors at the expense of decreased overall survival. In this study we compare the results in recurrent ALL patients transplanted with either HLA identical sibling bone marrow or partially matched related bone marrow. Thirty-two patients with relapsed ALL received partially matched bone marrows from a relative with one to three HLA, A, B and Dr antigen mismatches. Bone marrow was partially T cell-depleted with murine T10B9.1A-31 moAb. Sixteen patients with relapsed ALL received HLA-matched sibling bone marrows. All partially matched patients received additional GVHD prophylaxis with methylprednisolone in addition to anti-CD5 immunotoxin and/or CYA. All matched patients in addition to methylprednisolone received MTX and/or CYA. We observed no difference in disease-free survival between patients transplanted with partially matched bone marrow (median follow-up 1252 days, range 778-2035 days) vs those transplanted with HLA-matched bone marrow (median follow-up 1472 days, range 1165-2800 days; P = 0.48). Median survival for all patients is 38% (95% CI 24-52%) at 6 years. Patients transplanted in remission had a significant increase in disease-free survival when compared to those in relapse (P = 0.007). Our data suggest that partially matched BMTs from related donors are a comparable alternative to fully matched transplants in patients with ALL.

Adolescent↗
PubMed1996

Long-term survival in advanced chronic myelogenous leukemia following bone marrow transplantation from haploidentical related donors.

From 1987 to 1991, 26 patients with CML and a median age of 31 years received allogeneic BMT from a partially mismatched related donor (PMRD) who shared at least one haplotype with the recipient. Nine patients were in accelerated phase (AP), and 11 patients were in blast crisis (BC) at the time of BMT. Patients were mismatched either in graft-versus-host or host-versus-graft directions for one antigen in 3 patients, two antigens in 14 patients, and three antigens in 9 patients. All patients were prepared with a regimen consisting of total body irradiation, etoposide, cytosine arabinoside, cyclophosphamide and methylprednisolone. All marrows were treated ex vivo with T10B91.A-31, a monoclonal antibody directed toward the alpha beta heterodimer of the CD3 receptor, and rabbit complement. Additional GVHD prophylaxis included either the anti-CD5 immunoconjugate XomaZyme-H65, cyclosporine, or both in combination with methylprednisolone. Eight patients did not have sustained engraftment. The 100-day survival was 42%. The incidence of > or = grade II acute GVHD was 29%. The incidence of chronic GVHD was 50% and was limited in all cases. The median survival at 4 years for all 26 patients was 27%. Seven patients (CP 1, AP 3, BC 3) remain in hematologic remission 1297-2241+ days after transplantation. AlloBMT from a PMRD may be considered for patients with advanced CML who lack a matched sibling or unrelated donor.

Adolescent↗
PubMed1996

CREG matching for first cadaveric kidney transplants (TNX) performed by SEOPF centers between October 1987 and September 1995. Southeastern Organ Procurement Foundation.

The Southeastern Organ Procurement Foundation (SEOPF) data base from October 1987 to September 1995 included 12,536 first cadaveric kidney transplants, of which 39.5% were placed into non-white recipients (N-WR). Consequently, the SEOPF data offered an excellent sample in which to examine the effect of a number of conventional HLA-A, B versus public (crossreactive group, CREG) matching schemes on access and graft survival (GS). The standard applied was that 3-yr GS had to be greater than that of the mean GS of the racial group. Because of the excellent 1- and 3-yr GS of 0 A, B, DR mismatched kidneys in both white recipients (WR) = 87.9% and 82.8% and N-WR = 86.9% and 80.9%, these transplants were excluded from further analysis. Thereafter, the mean 1- and 3-yr GS of the remaining 7011 WR and 4862 N-WR, transplants used for all subsequent comparisons were 82.5% and 72.4% for WR versus 80.9% and 63.0% for N-WR. Four different matching schemes were compared: 1) Class I A, B versus CREG hierarchical effect disregarding DR; 2) 0, 1, 2B, DR versus 0-2 CREG, DR mismatching; 3) DR mismatching disregarding Class I A, B or CREG mismatching and 4) Class I A, B versus CREG mismatching stratified for DR. Two and possibly three CREG, DR mismatched groups were identified in which improved access and GS occurred in comparison with the 0, 1, and 2B, DR mismatched transplants currently receiving 7, 3 and 1 point in the UNOS sharing algorithm. The 1- and 3-yr GS in WR and N-WR of these groups were as follows: 0 CREG, 0 DR mismatches: 85.7% and 78.3% in WR (n = 385); 83.0% and 69.4% in N-WR (n = 157). 1-3 CREG, 0 DR mismatches: 84.5% and 74% in WR (n = 1550); 82.7% and 65.7% in N-WR (n = 1083). Based on this analysis, there may be a significant potential advantage of prospective Class I CREG over A, B matching for first cadaver kidney transplantation.

Algorithms↗
PubMed1996

Utility of DRB1 subtyping: a case report.

The purpose of presenting this case is to illustrate the importance of high-resolution DNA Class 2 typing when assignment of MHC antigens is of extreme importance (i.e. bone marrow transplantation); suggest this test as a substitute for the mixed lymphocyte culture (MLC), and provide evidence that DRB1 subtype mismatches may be clinically significant. Initial serological and monoclonal HLA Class 1 and low-resolution DNA-SSP Class 2 typing of a potential bone marrow transplant patient and two sisters revealed all to be HLA identical with apparent homozygosity for DRB1 x 04. High-resolution DNA-SSP Class 2 typing was then performed and revealed electrophoretic banding patterns which were not specific for any DRB1 x 04 subtype. One sister and the patient had identical patterns, while the other sister had a different pattern. Complete HLA Class 1 and high-resolution DNA-SSP Class 2 typing of the parents was performed. The mother was found to be heterozygous for Class 1 and Class 2 antigens and possess the DRB1 x 0404, 0405 subtypes. In contrast, the father was found to be homozygous for Class 1 antigens, heterozygous for Class 2 antigens and possess the DRB1 x 0404, 0407 subtypes. This led to the initial false assumption of HLA identity for the patient and her two sisters. However, assignment of haplotypes revealed one sister to be HLA identical with the patient and the other sister to be a one-haplotype five-antigen match with the patient, mismatching for one DRB1 allele. Bone-marrow transplantation was performed utilizing the latter sister, which resulted in intractable acute graft vs. host disease that resulted in the patient's demise.

Acute Disease↗
PubMed1996

T10B9 (MEDI-500) mediated immunosuppression: studies on the mechanism of action.

The murine IgM anti-human CD3/TCR mAb T10B9 is an effective agent for the reversal of acute cellular renal allograft rejection which offers several advantages over conventional OKT3 therapy. These include reduced morbidity and a more rapid decrease in serum creatinine levels. In the studies presented here comparing T10B9 and OKT3, soluble T10B9 is shown to be a nonactivating anti-T cell mAb. Evidence for its lack of activating potential includes in vitro failure to stimulate PBMC proliferation either alone or in the presence of nonmitogenic doses of phorbol ester, failure to induce the expression of early and late activation antigens and failure to induce IFN-gamma, TNF-alpha, IL-6 or IL-2 release. Analysis of acute renal allograft rejection patient plasma cytokine levels 2 h after the first dose support the hypothesis that T10B9 has reduced immunoactivation activity in vivo. Both TNF alpha and IFN gamma patient plasma levels are significantly reduced in T10B9 as compared to OKT3 therapy. However, T10B9 is capable of cellular signaling as demonstrated by its ability to induce apoptosis and IL-2 release in the human T cell line Sup-T13. Thus T10B9 retains the potent immunosuppressive activity of OKT3 with reduced immunoactivation.

Antibodies, Monoclonal↗
PubMed1995

The effect of human IL-2-activated natural killer and T cells on graft-versus-host disease and graft-versus-leukemia in SCID mice bearing human leukemic cells.

We have previously reported that xenogeneic lethal acute graft-versus-host disease (GVHD) was induced by transplantation of a mixture of human IL-2 activated natural killer (NK) and T cells into SCID mice conditioned with 4 Gy total-body irradiation (TBI), but not by IL-2-activated pure human T cells or NK cells. TBI and transplantation of the mixture of activated cells were both required to produce the lethal effect. We now report the effect of human IL-2 activated NK, T, or NK+T effector cells on the development of acute and chronic GVHD and GVL in SCID mice bearing human leukemic cells. Ten days after being inoculated i.v. with 2 x 10(7) human U-937 or K-562 leukemic cells, SCID mice, hereafter termed hu-leukemic mice, were radiated with 4 Gy TBI and transplanted i.v. with 5 x 10(7) human IL-2-activated NK, T, or NK+T effector cells. Hu-leukemic control mice received neither TBI nor effector cell transplantation. Acute GVHD-positive control SCID mice were transplanted with 5 x 10(7) H-2-incompatible C57Bl/6 splenocytes following 4 Gy TBI. The mice were observed for signs of GVHD and leukemia for 90 days. Twenty of 20 non-effector cell-transplanted control hu-leukemic mice developed signs related to leukemia and died with leukemic infiltration in the brain, liver, kidney, and lung 50-65 days after inoculation. Flow cytometry (FC) demonstrated 21-89% human leukemic cell infiltration in the bone marrow. Fourteen of 14 hu-leukemic mice transplanted with NK+T effector cells did not develop signs of advanced leukemia but died within 17 days of acute GVHD. FC demonstrated no human leukemic cells in their marrow. Twelve of 15 and 18 of 25 hu-leukemic mice transplanted with either NK or T cells survived 90 days without any evidence of symptomatic leukemia (P < 0.01 compared with non-effector cell-transplanted groups). NK-transplanted hu-leukemic animals experienced mild-to-moderate acute GVHD during the first 10-20 days posttransplantation, but gradually recovered and did not develop chronic GVHD. Hu-leukemic animals transplanted with T effector cells manifested no signs of leukemia or acute GVHD but chronic GVHD skin lesions appeared 80-90 days after transplantation. We conclude that acute GVHD, chronic GVHD, and GVL are associated but separable phenomena.

Animals↗
PubMed1995

Pancreatic complications after distal splenorenal shunt.

Pancreatic complications after the distal splenorenal shunt have not been commonly recognized. Between January 1978 and June 1993, 154 patients underwent a distal splenorenal shunt, and 11 patients (7%) developed pancreatic complications, of which 4 had pancreatitis alone, and 7 developed pancreatitis-related complications. Etiology of cirrhosis, Child's classification and timing of surgery were not predictive of pancreatic complications. Eight patients (5%) were found to have chronic pancreatitis at the time of surgery, and four of these patients (50%) developed pancreatic complications following distal splenorenal shunt. Eleven early postoperative deaths in our series resulted in an overall operative mortality rate of 7%. Of these eleven patients, 6 (55%) had postoperative pancreatic complications. The operative mortality rate of patients who developed pancreatic complications (55%) after distal splenorenal shunt was significantly greater than that of patients who did not develop pancreatic complications (3%), P < .001. When compared with patients without pancreatitis, those with pancreatitis had significantly greater incidences of complete or partial portal vein thrombosis (55% v 20%, P < .02), severe ascites (64% v 13%, P < .001), and encephalopathy (45% v 3%, P < .001). We reach the following conclusions: (1) although not a frequent complication after distal splenorenal shunt in general, pancreatitis was commonly present in early postoperative deaths and was most likely a major contributor to the demise of those patients; (2) survivors with postdistal splenorenal shunt pancreatitis had a markedly increased morbidity rate; and (3) pancreatic complications after distal splenorenal shunt are more likely to occur in patients with pre-existing chronic pancreatitis.

Abscess↗
PubMed1995

Laparoscopic gastrostomy: a safe method for obtaining enteral access.

Laparoscopic gastrostomy is a relatively new procedure which does not require a laparotomy but which allows direct visualization of the gastrostomy tube entering the stomach and the stomach-parietal peritoneum interface. The role of the laparoscopically placed gastrostomy for enteral access has yet to be defined. Our aim was to compare laparoscopic gastrostomy with open surgical gastrostomy to determine the effectiveness and safety of laparoscopic gastrostomy as a method for obtaining long term enteral access. We reviewed the records of 32 patients (December 1992 to April 1994) who had laparoscopic gastrostomy (group I) and 37 patients (January 1987 to December 1993) who had open gastrostomy (group II). The indications, length of operation, and morbidity and mortality rates in both groups were compared. The underlying diseases and indications for gastrostomy placement were similar in both groups. Both groups included primarily patients who were not candidates for upper endoscopy. Operative time was significantly shorter in the laparoscopic gastrostomy group (38 +/- 7 min) than in the open gastrostomy group (62 +/- 19), P < 0.0001. Major complication for laparoscopic gastrostomy was 6% and for open gastrostomy was 11%. There was no procedure-related mortality in group I and three patients in group II died in the immediate postoperative period. Major morbidity and mortality rates were not significantly different between the two groups. Laparoscopic gastrostomy is a safe and effective alternative to open gastrostomy, particularly in patients unable to undergo upper endoscopy or in patients undergoing a concomitant laparoscopic procedure.

Evaluation Studies as Topic↗
PubMed1995

Effect of reversed intestinal segments on intestinal structure and function.

Our aim was to evaluate the short-term effect of a reversed segment on structural and functional intestinal adaptation. Ten dogs underwent 75% distal resection and serosal electrode placement with (RS, n = 5) or without (RO, n = 5) reversal of the terminal 10 cm of the remnant. Nutritional status, absorption, motility, hormonal response, and remnant adaptation were studied at 4, 8, and 12 weeks. Both groups lost weight (RO 89 +/- 3% and RS 76 +/- 8% of initial wt at 12 weeks). Hypoalbuminemia occurred in the RS animals (2.5 +/- .4 vs 2.9 +/- 4 g/dl, P < 0.05). Caloric intake was lower in RS animals during the first 2 weeks. Stool weight increased transiently (4 and 8 weeks) after RO (239 +/- 92 and 249 +/- 25 g/day vs 101 +/- 42 g/day, preop, P < .05) but not RS. Stool fat was elevated in both groups. Remnant length increased after RO (90 +/- 16 to 110 +/- 21 cm) but not after RS (89 +/- 8 vs 86 +/- 9 cm). Morphometric changes were similar. Plasma PYY was increased after RO but not RS animals. Changes in tissue neuropeptides were similar. Intestinal transit time was increased 4 weeks after RS (19 +/- 9 vs 10 +/- 2 min) but was similar to RO thereafter. Myoelectrical activity in the reversed segment was persistently reversed and independent; only 11% of proximal Phase 3 complexes were propagated into the reversed segment. The dominant motor pattern within this segment was orad-migrating clusters and prolonged spike bursts.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Physiological↗
PubMed1995

Anal sphincteroplasty for incontinence after ileal pouch-anal anastomosis. Report of two cases.

PURPOSE: This report reviews two patients who underwent anal sphincteroplasty to improve continence after ileal pouch-anal anastomosis (IPAA). METHODS: A retrospective study of two patients was performed. RESULTS: Two patients underwent anal sphincteroplasty after IPAA for incontinence, one diagnosed preoperatively and one postoperatively. Both had had previous anal surgery. Satisfactory continence was achieved in both cases, despite modest changes in manometric studies. CONCLUSION: Anal sphincteroplasty should be considered after IPAA. The value of anorectal manometry in this situation is equivocal.

Adult↗
PubMed1995

Regional variation in canine intestinal muscle mass and function.

Our aim was to investigate the contribution of variations in intestinal muscle morphology or function to regional differences in motor properties in vivo. We quantitated intestinal muscle thickness and surface area along the canine gut and compared the in vitro contractile properties of the jejunum and ileum. The thickness and cross-sectional surface area of both circular and longitudinal muscle demonstrated a parabolic distribution along the intestine, with the greatest values occurring in the proximal and distal regions. The terminal ileum had the greatest circular (885 +/- 194 microns) and longitudinal muscle (367 +/- 135 microns) thickness. Circular muscle was 2.5-3 times thicker than longitudinal muscle at all points. Passive tension was similar in muscle strips from the mid-jejunum, mid-ileum, and terminal ileum (2.8 +/- 0.8, 2.5 +/- 0.4, and 2.3 +/- 0.8 vs 2.5 +/- 0.5, 1.9 +/- 0.5, and 2.8 +/- 1.0, longitudinal and circular, respectively). Active and total tension, however, were significantly greater in longitudinal than circular muscle in mid-jejunum (active; 8.5 +/- 1.4 vs 5.6 +/- 1.2, P < 0.05 and total 11.3 +/- 1.7 vs 8.1 +/- 1.2) and in mid-ileum (active 9.5 +/- 1.6 vs 5.8 +/- 1.2 and total 12.0 +/- 1.6 vs 7.7 +/- 1.2). Values for each layer were similar in both sites. In contrast, in the terminal ileum, longitudinal and circular muscle strips demonstrated similar active (10.1 +/- 1.7 vs 9.0 +/- 2.7, NS) and total tension (12.4 +/- 2.0 vs 11.9 +/- 3.4, NS). Dose-response curves to carbachol (10(-8)-10(-2) M) were similar in all these regions. We conclude (1) there are regional variations in muscle mass but contractile properties are similar in jejunum and ileum; and (2) the unique motor properties of the terminal ileum may be related more to differences in muscle morphology and neural input than intrinsic function.

Animals↗