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Biomedical subjects

K M Sullivan

Publications and source records attributed to K M Sullivan.

At least 271 records · Page 15Linked to original sources
PubMed1985

Infection with varicella-zoster virus after marrow transplantation.

Infection with varicella-zoster virus (VZV) occurred in 231 (16.6%) of 1,394 patients undergoing marrow transplantation in Seattle, Washington, between 1969 and 1982. The probability of VZV infection was 30% by one year after transplant. Eighty percent of infections occurred within the first nine months after transplant, and of these cases 45% had cutaneous or visceral dissemination. Twenty-three deaths were associated with VZV infection, all within the initial nine months after transplant. Postherpetic neuralgia, scarring, and bacterial superinfection were also significantly more frequent among patients with VZV in the first nine months after transplant (32%) than among patients with later infection (19%; P less than .05). By multivariate analysis, allogeneic transplant, acute or chronic graft-vs.-host disease, patient age between 10 and 29 years, diagnosis other than chronic myelogenous leukemia, and posttransplant use of antithymocyte globulin were each risk factors for VZV infection. Among infected patients, the only significant risk factor for VZV dissemination or death was acute graft-vs.-host disease (P less than .03 and P less than .0002, respectively.

Adolescent↗
PubMed1985

Treatment of human acute graft-versus-host disease with antithymocyte globulin and cyclosporine with or without methylprednisolone.

Forty-eight patients with hematologic malignancies treated by allogeneic marrow transplantation developed acute graft-versus-host disease (GVHD), grades II-IV, despite prophylaxis with methotrexate. They were treated with a combination of antithymocyte globulin (ATG) and cyclosporine (CsA), with or without the addition of methylprednisolone (MP). Thirty patients had received HLA-identical and 18 HLA-nonidentical transplants. Median onset of GVHD was day 13 (range 8-60) for patients with HLA-nonidentical grafts and day 18 (range 7-48) for patients given HLA-identical grafts (P = 0.01). Forty-five patients could be evaluated for response on day 7 of therapy. Among these, 13 of 27 given ATG/CSP and 6 of 18 given ATG/CSP/MP improved. Among 33 patients evaluable on day 14 of therapy 13 of 19 given ATG/CSP and 5 of 14 given ATG/CSP/MP showed improvement of GVHD. Patients given HLA-nonidentical grafts responded somewhat (although not significantly) less frequently than patients given HLA-identical grafts. Chronic GVHD developed in 16 of 18 evaluable patients given ATG/CSP and in 5 of 6 given ATG/CSP/MP. Viral, bacterial, and fungal infections were the major cause of death in both groups. Interstitial pneumonitis was more frequent among patients given ATG/CSP/MP. Survival beyond 6 months was 67% among patients treated with ATG/CSP and 25% with ATG/CSP/MP. These data indicate that a regimen of ATG/CSP is of value in the treatment of acute GVHD. The addition of MP was not beneficial and resulted in decreased survival--presumably because of excessive immunosuppression and associated complications.

Adolescent↗
PubMed1985

Allogeneic marrow transplantation in the treatment of MOPP-resistant Hodgkin's disease.

Eight patients with disseminated Hodgkin's disease resistant to MOPP (mechlorethamine, vincristine, procarbazine, and prednisone) chemotherapy were treated with high-dose chemoradiotherapy and marrow transplantation from an HLA-identical sibling. Two patients remain alive in unmaintained complete remission (CR) at 38 and 39 months after transplant. In the other six patients, reasons for failure included relapse of lymphoma (two patients), or death due to complications of the transplant procedure, including Legionnaire's disease, disseminated zoster, graft-v-host disease, and aspiration pneumonia secondary to severe mucositis. These results demonstrate that some patients with MOPP-resistant Hodgkin's disease can obtain prolonged CR following intensive chemoradiotherapy and allogeneic marrow transplantation.

Adult↗
PubMed1985

Mumps disease and its health impact: an outbreak-based report.

An outbreak of mumps in a middle school (grades 6 to 8) in Ohio during 1981 was investigated to describe the clinical findings, health impact, and costs. Individuals with clinical mumps in the middle school and in family members were questioned concerning symptoms, complications, hospitalizations, school days absent, and parental work days missed. There were 62 cases of clinical mumps in the middle school and 13 cases among family members. Parotitis lasted an average of 7.4 days and fever (if present) lasted an average of 2.5 days with a mean temperature of 38.6 degrees C (101.4 degrees F). The duration of parotitis and fever increased with age. Complications included encephalitis, aseptic meningitis, orchitis, oophoritis, mastitis, and pancreatitis. Visits to physicians were made by 62.7% (47/75) of the individuals with mumps for a total of 63 visits, and two patients were hospitalized for a total of six days. Persons who attended middle school missed an average of 4.9 days of school. The estimated direct and indirect costs associated with this outbreak were $2,460 and $1,353, respectively, or $51 per case. States lacking mumps immunization requirements experienced a three-times greater incidence of mumps in 1982 than States that required all school pupils to be immunized. We recommend that all States institute compulsory mumps school immunization laws for all school children.

Absenteeism↗
PubMed1985

Mumps in Ohio.

Explore the source record for details and available documents.

Adolescent↗
PubMed1984

Association between cyclosporin neurotoxicity and hypomagnesaemia.

The serum magnesium levels of all 12 allogeneic bone-marrow transplant recipients who experienced the neurotoxic effects of cyclosporin (CyA) were more than two standard deviations below the normal range. The neurological events seemed to segregate into three separate syndromes. 7 patients had grand-mal seizures, which occurred within the first several weeks of CyA therapy (median onset 12 days). At the time of their first seizure all 7 patients had hypomagnesaemia, which had developed rapidly over the preceding 1-3 weeks. 3 patients had four episodes of cerebellar ataxia, tremor, and depression. These subacute episodes developed after prolonged CyA therapy (median onset 67 days). Each episode was associated with hypomagnesaemia. 2 patients had a transient episode of expressive aphasia following a long period of hypomagnesaemia. In all cases symptoms resolved or did not recur with adequate magnesium replacement. These data suggest that CyA neurotoxicity is associated with hypomagnesaemia and may be treated or prevented with magnesium replacement.

Adolescent↗
PubMed1984

Marrow transplantation in hepatitis-associated aplastic anemia.

Seventeen patients who developed aplastic anemia in association with viral hepatitis were transplanted with sibling marrow. Of the 16 HLA-identical recipients, 14 were conditioned with cyclophosphamide, 200 mg/kg, and two received 10 Gy total body irradiation. One HLA-nonidentical recipient received 123 mg/kg cyclophosphamide and 10 Gy total body irradiation. Of the 14 patients conditioned with cyclophosphamide alone, one died on day 49 after graft rejection, and 13 had sustained engraftment. Six of the 13 developed acute graft-versus-host disease (GVHD), which led to death from opportunistic infections 84, 97, and 130 days after transplantation in three patients. Four of the 13 developed chronic GVHD, two without preceding acute GVHD. Currently, ten of the 14 cyclophosphamide-conditioned patients are alive 0.9-12.4 (median 5.9) years from transplantation. The two HLA-identical recipients conditioned for grafting with total body irradiation died after failure of engraftment, and one also developed concomitant hepatic venocclusive disease. The mismatched recipient conditioned with radiation and cyclophosphamide died of severe GVHD 18 days posttransplant. We conclude that survival, graft rejection, and incidence of acute and chronic GVHD after marrow transplantation for hepatitis-associated aplastic anemia are similar to those of patients transplanted for aplastic anemia of other etiologies. Previous hepatic damage from viral hepatitis and liver function abnormalities existing at the time of grafting do not appear to increase the risk of posttransplant morbidity and mortality from hepatocellular damage or venocclusive disease in cyclophosphamide-conditioned patients.

Adolescent↗
PubMed1984

Prophylaxis of infection in patients with aplastic anemia receiving allogeneic marrow transplants.

One hundred one patients with severe aplastic anemia underwent allogeneic marrow transplantation and received one of three forms of infection prophylaxis: oral nonabsorbable antibiotics and isolation and decontamination in a laminar airflow room (36 patients); prophylactic granulocyte transfusions from a single family member donor (33 patients); or conventional treatment in single rooms with hand-washing and mask precautions (31 patients). During the period of granulocytopenia, patients in the laminar airflow rooms acquired fewer infections than either of the other groups, but this difference was statistically significant only when compared with the group receiving conventional treatment. Patients in the laminar airflow rooms had significantly fewer infections after engraftment as compared with the other two groups. Incidence of interstitial pneumonia and graft rejection was not different among the three groups. Acute graft-versus-host disease occurred later (Day 47) in the group in the laminar airflow rooms as compared with the group receiving prophylactic granulocyte transfusions (Day 23) or the group receiving conventional treatment (Day 20). The incidence of grades II to IV acute graft-versus-host disease was less in the patients in the laminar airflow rooms but only reached borderline significance (p = 0.08) when compared with the conventionally treated patients. The survival at Day 100 was 92 percent for the group in the laminar airflow rooms, 79 percent for the group receiving prophylactic granulocyte transfusions, and 64 percent for the group receiving conventional treatment.

Adolescent↗
PubMed1984

Cataracts after total body irradiation and marrow transplantation: a sparing effect of dose fractionation.

We examined 277 patients, who have been followed for 1 to 12 years after marrow transplantation, for cataract development. In preparation for transplantation, 96 patients with aplastic anemia were conditioned with chemotherapy only, usually cyclophosphamide 50 mg/kg X 4 intravenously, while 181 patients (two with aplastic anemia and 179 with a hematologic malignancy) were conditioned with a regimen of total body irradiation (TBI) and chemotherapy. TBI was delivered from two opposing 60Co sources at an exposure rate of 4 to 8 cGy/min, either as a single dose of 10 Gy (105 patients) or in fractions (76 patients), usually at increments of 2 to 2.25 Gy/day for 6 to 7 days for cumulative doses of 12 to 15.75 Gy. To date, 86 patients have developed cataracts. Kaplan-Meier product limit estimates of the incidence of cataracts for patients given chemotherapy only and no TBI, single-dose TBI, and fractionated TBI are 19, 80, and 18%, respectively. On the basis of proportional hazards regression analyses, patients given single-dose TBI had a relative risk of developing cataracts that was 4.7-fold higher than in patients given fractionated TBI or chemotherapy only (p less than 0.00005), suggesting a significant sparing effect with use of TBI dose fractionation. Addition significant risk factors included the chronic use of steroids posttransplant (highly associated with the presence of chronic graft-versus-host disease), and the diagnoses of acute lymphoblastic or chronic myelogenous leukemia.

Adolescent↗
PubMed1984

Radiographic features of esophageal involvement in chronic graft-vs.-host disease.

Chronic graft-vs.-host disease (GVHD) is an important late complication of allogeneic bone-marrow transplantation. It resembles several naturally occurring autoimmune diseases and involves the skin, mouth, eyes, liver, and esophagus. The radiographic findings of 14 symptomatic patients with chronic GVHD involving the esophagus were reviewed and found to include webs, ringlike narrowings, and tapering strictures in the mid and upper esophagus. Esophagoscopy revealed characteristic desquamation in the 13 patients studied, but barium studies detected this lesion in only one patient. Knowledge of the site and characteristics of esophageal involvement with chronic GVHD assists the radiologic evaluation of this disorder.

Adolescent↗
PubMed1984

Allogeneic marrow transplantation.

After 15 years of clinical investigation, allogeneic marrow transplantation can be considered the treatment of choice for a variety of hematologic and immunologic diseases. This review has focused upon some of the principles, current results, problems, and future directions in allogeneic marrow grafting.

Acute Disease↗
PubMed1984

Rapidly progressive air-flow obstruction in marrow transplant recipients. Possible association between obliterative bronchiolitis and chronic graft-versus-host disease.

Severe obstructive airways disease developed in 4 young nonsmoking adults after marrow transplantation. They were free of respiratory disease until symptoms developed 277 to 600 days after transplant. Pulmonary function testing showed that the mean forced expiratory volume in one second was 35% of predicted (range, 23 to 49%). All patients had active or inactive extensive chronic graft-versus-host disease that included oral mucositis, esophagitis, sinusitis, and oral and ocular sicca. Three patients had subnormal serum IgA levels. Bronchitis was apparent during fiberoptic bronchoscopy in 3 patients. An open-lung biopsy specimen from 1 patient showed obliterative bronchiolitis. Treatment has included bronchodilators and corticosteroids without objective benefit. The disorder stabilized in all 4 patients, but a severe reduction in air flow persisted. Awareness of this complication may lead to earlier diagnosis and more effective treatment.

Adolescent↗
PubMed1984

Oral manifestations of chronic graft-v-host disease.

Sixty patients were studied 180 to 500 days after allogeneic marrow transplantation to determine if late oral abnormalities were associated with the presence of chronic graft-v-host disease (GVHD). Lip and intraoral mucosal surfaces were evaluated for color, keratinization, atrophy, and erythema. Subjective complaints of oral pain and xerostomia were also recorded. Abnormalities were scored on a scale of 0 to 3 and tested for association with GVHD by chi 2 test. Oral manifestations most strongly associated with chronic GVHD included atrophy and erythema or lichenoid lesions of the buccal and labial mucosa and oral pain. Oral manifestations resembled several naturally occurring autoimmune disorders. Recognition of these changes can aid in the clinical diagnosis and assessment of established chronic GVHD.

Adolescent↗
PubMed1984

Marrow harvesting from normal donors.

The experience at a single institution in harvesting marrow for allogeneic transplantation on 1,270 occasions from 1,160 normal donors is presented in detail, together with an analysis of all the donor complications. Four donors were less than 2 years old, and the youngest was 6 1/2 months. No special difficulties were encountered with these young donors. Hospitalization time was three days or less for 99% of the procedures. Six donors had life-threatening complications; three of a cardiopulmonary and two of an infectious nature, and one cerebrovascular embolic episode. Significant operative site morbidity, usually transient neuropathies, occurred in ten procedures. Ten percent of the donations were associated with transient postoperative fever of unknown origin. Increasing donor age was associated with a reduction of the cellularity of the marrow harvest. The use of stored autologous blood permitted the avoidance of blood bank transfusion in 81% of males, 69% of females, and 50% of children. It was concluded that the procedure was associated with a very low risk of complication, but that the involvement of normal donors in such an operation justifies stringent monitoring.

Adolescent↗
PubMed1983

Graft-versus-host disease and survival in patients with aplastic anemia treated by marrow grafts from HLA-identical siblings. Beneficial effect of a protective environment.

One hundred thirty patients with severe aplastic anemia were conditioned with cyclophosphamide for transplantation of marrow from HLA-identical siblings. The patients were selected for the present analysis according to the criterion of sustained marrow engraftment. Of the 130 patients, 97 are now alive between 1.4 and 11 years (median, 5) after transplantation. Twenty-nine of the thirty-three who died had either acute or chronic graft-versus-host disease (GVHD). Our analysis was directed at identifying factors predicting GVHD and survival after transplantation in patients. Our key findings were that moderately severe to severe acute GVHD had a strong adverse influence on survival; that a protective environment significantly reduced mortality, which corresponded in part to a reduction in and delayed onset of acute GVHD; that refractoriness to random-donor platelet infusions at transplantation adversely influenced survival, particularly among patients with acute GVHD; and that increasing age was associated with increased mortality.

Adult↗