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Biomedical subjects

S Todo

Publications and source records attributed to S Todo.

At least 181 records · Page 10Linked to original sources
PubMed1996

"Munchausen by proxy" syndrome in a small bowel transplant recipient.

Munchausen by Proxy is potentially one of the most harmful forms of child abuse with a reported mortality rate of nearly 10% and may be a secondary cause of chronic intestinal pseudo-obstruction. If MBP is suspected, prompt action should be taken to separate the mother and child to determine if the symptoms are legitimate or fabricated. Successful treatment depends on the collaboration between disciplines and cooperation of all staff members. It is important that MBP be ruled out in cases of CIP when these children are evaluated for transplant to prevent needless morbidity.

Adolescent↗
PubMed1996

[Clinical intestinal transplantation at the University of Pittsburgh: an update].

From May 1990 until August 1996, 87 patients received 92 intestinal transplantation, including an isolated graft (n = 33), combined liver and intestinal grafts (n = 41), and abdominal multivisceral grafts (n = 13). There were 52 children (mean age 3.3 years) and 35 adult patients (mean age 32.6 years). Of these, 29 patients received the colon as a composite of the intestinal graft, and 11 recent patients were given unmodified donor bone marrow cells simultaneously. Postoperative immunosuppression was with Tacrolimus and low-dose steroids, to which either azathioprine, mycophenolate, or cyclophasphamide was added supplementarily. One-, three-, and five-year patient and graft survival was 73% and 64%, 44% and 36%, and 444% and 36%, respectively. There was no statistical difference in patient and graft survival after different types of intestinal transplantation. Although overall patient and graft survival did not differ between pediatric patients and adult recipients, isolated graft survival children was higher than that of adult recipients (57% versus 11% at three years). Transplantation of the grafts from CMV seropositive donors and the inclusion of the colon in the intestinal graft worsened the survival in adult recipients, but not in children. The influence of simultaneous bone marrow transplantation on the outcome is undetermined due to the short follow-up period. Intestinal transplantation has become feasible, but still requires improved immunosuppression and graft dysmotility management to be a clinical practice.

Adult↗
PubMed1995

Circulating ICAM-1, E-selectin, IL-2 receptor, and HLA class I in human small bowel, liver, and small bowel-plus-liver transplant recipients.

Recently, soluble(s) circulating isoforms of intercellular adhesion molecule-1 (sICAM-1) and sE-selectin (formerly endothelial leukocyte adhesion molecule-1) have been described in normal human serum. Elevated levels have been reported in acute and chronic inflammatory disorders, including allograft rejection. In this study, plasma levels of sICAM-1 and sE-selectin were determined in groups of tacrolimus (FK 506)-treated adult patients following either isolated small bowel (SB), liver, or combined SB plus liver (SB/L) transplantation. Each molecule was measured at 1, 2, 4, 6, 8, and 12 weeks (all patients) and at 6, 9, and 12 months after transplantation (SB and SB/L only) by enzyme linked immunosorbent assay. Levels were compared with those of soluble interleukin-2 receptor (sIL-2R; a marker of lymphocyte activation) and soluble HLA class I (which has been reported to be elevated in liver transplant-related complications). Elevations above normal in mean plasma levels of sICAM-1 (2.4-fold), sE-selectin (1.8-fold), sIL-2R (10.6-fold), and sHLA class I (1.3-fold) were found in patients with stable isolated SB grafts during the first 12 weeks posttransplant. Except for sHLA class I, levels of each protein were subsequently reduced, up to 1 year posttransplant. However, further increases in sICAM-1 and in sIL-2R and sE-selectin levels were observed during episodes of SB rejection compared with stable grafts. Mean levels of all molecules were higher in patients with isolated SB grafts compared with those given liver or combined (SB/L) transplants, either during stable SB graft function (up to 12 weeks posttransplant) or rejection. The data demonstrate increased adhesion molecule production/shedding following SB transplantation and are suggestive of a reduced overall level of immune activation in liver and SB/L compared with isolated SB transplantation.

Adult↗
PubMed1995

Hamster to rat kidney xenotransplantation. Effects of FK 506, cyclophosphamide, organ perfusion, and complement inhibition.

Hamster to rat renal xenotransplantation was performed with recipient nephrectomies. Recipients were treated beginning on day 0 with continuous FK 506 monotherapy, a 7-day or open-ended monotherapeutic course of cyclophosphamide (CP), and the two drug regimens combined. CP alone (10 mg/kg/day) prevented a xenospecific antibody response and tripled median survival of the kidney (defined as recipient death) from 6 (control) to 18.5 days whereas FK 506 alone had no effect. The drugs in combination were no better than CP alone (15 days) unless the 5-day course of CP was given at a higher dose (15 mg/kg) and started 3 days preoperatively (79 days). In further experiments, adjuvant measures were added to the minimally effective FK 506/7-day CP regimen which gave a median survival of only 15 days. In the most successful modification, intraoperative antibody depletion by the temporary transplantation of third party hamster liver or en bloc kidneys increased median survival from 15 to 34 and 48 days, respectively. An intraoperative i.v. dose administration of the anticomplement drug K76 instead of antibody depletion increased survival to 26 days. Although the events of kidney rejection were similar to those of heart xenografts and partially forestalled by the antibody inhibiting CP treatment, or by antibody depletion, survival for > 100 days was accomplished in only 5 of 86 treated animals. The poorer survival previously reported with cardiac xenotransplantation is largely explained by the life support requirement of the kidneys. Renal failure was responsible for almost all deaths before 60 days, and subnormal renal failure was a pervasive adverse factor thereafter, frequently caused by pyelonephritis which is suspected to have had an immunologic etiology.

Animals↗