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Biomedical subjects

G A DeVault

Publications and source records attributed to G A DeVault.

9 recordsLinked to original sources
PubMed1994

The effects of oral pentoxifylline on the cytokine release syndrome during inductive OKT3.

The cytokine release syndrome (CRS) accompanying OKT3 therapy is a major cause of posttransplant morbidity. The pathogenesis of this syndrome has been attributed to the synthesis of tumor necrosis factor, interleukin 2 (IL-2), interleukin 6 (IL-6), and gamma-interferon in response on T lymphocyte stimulation by OKT3. The hemorrheologic agent pentoxifylline (PTX) inhibits the synthesis of TNF alpha in vitro in response to a variety of stimuli, including OKT3. We performed a randomized, double-blinded trial of PTX during OKT3 induction in recipients of cadaveric renal allografts. Patients received either PTX 800 mg or placebo 2 hr before the initial dose of OKT3 and every 8 hr thereafter during the first 3 posttransplant days. Serum TNF alpha and IL-6 concentrations were measured pre-OKT3 and at 2 and 6 hr post-OKT3 on the first 3 posttransplant days. Despite the achievement of apparently adequate plasma levels of PTX and its active metabolites, no difference was observed in the incidence or severity of clinical manifestations of CRS. Serious manifestations of CRS--including acute pulmonary edema, encephalopathy, and aseptic meningitis--were not seen in either group. Serum TNF alpha and IL-6 concentrations were similar in PTX and control patients throughout the course of the study. Plasma levels of PTX and its active metabolites did not correlate with serum TNF alpha levels, serum IL-6 levels, or the incidence and severity of clinical manifestations of CRS.

Adult↗
PubMed1994

Chronic rejection.

Current immunosuppressive protocols have significantly decreased graft loss to acute rejection but have had no effect on graft loss to chronic rejection. Recently, attention has been focused on the prevention and management of chronic rejection. Centers must come to a uniform definition of this phenomenon so that studies can be compared. It is believed that the definition should include both a typical clinical course and a definitive biopsy. For kidney transplant recipients, the major risk factor for the development of chronic rejection appears to be a previous acute rejection episode. Other important risk factors include low-dose maintenance immunosuppression and previous infection. Noncompliance probably plays a role in some patients. For extrarenal transplant recipients, chronic rejection has been associated with cytomegalovirus infection and/or HLA-DR matching. Immunoregulatory processes posttransplant may modify or attenuate the development of chronic rejection. Large, prospective clinical studies are required to further elucidate risk factors and to determine the effect of intervention.

Chronic Disease↗
PubMed1993

A prospective study on treatment of hypercholesterolemia with lovastatin in renal transplant patients receiving cyclosporine.

Hypercholesterolemia occurs commonly in renal transplant recipients and may contribute to the high cardiovascular morbidity and mortality in these patients. Although an effective hypolipidemic agent, lovastatin has been associated with rhabdomyolysis and acute renal failure in patients on cyclosporin A (CsA). In this study, lovastatin was administered at 10 mg/day for 8 wk followed by 20 mg/day for 12 wk to six renal transplant recipients who were receiving CsA concomitantly. The 10-mg/day dose was effective, but an additional lipid-lowering effect was seen with the 20-mg/day dose. Both serum total cholesterol and low-density lipoprotein cholesterol levels decreased by 27% at the end of the 20 wk of lovastatin administration. Serum high-density lipoprotein cholesterol and triglyceride levels remained unchanged. No significant clinical or laboratory adverse effects were observed, including muscular symptoms, ophthalmologic abnormalities, or alterations in serum creatine kinase, urea nitrogen, creatinine, transaminases, and CsA levels. Peak and trough plasma concentrations of active lovastatin were comparable to those reported in normal subjects receiving a higher lovastatin dose without CsA. It was concluded that the administration of low-dose (10 to 20 mg/day) lovastatin to renal transplant recipients receiving concomitant CsA can be safe and effective in lowering serum cholesterol.

Adult↗
PubMed1988

Complications from permanent hemodialysis vascular access.

From 1981 to 1986 a total of 499 operations were performed for permanent hemodialysis vascular access in 230 patients. At least 1 year's follow-up was achieved in all cases. This series is divided into 326 primary procedures and 173 secondary procedures. Of the primary procedures, there were 160 autogenous fistulas and 166 expanded polytetrafluoroethylene (PTFE) fistulas. The 156 secondary procedures consisted of 124 thrombectomies, 20 repairs of pseudoaneurysm, 12 fistula ligations, and 17 fistula excisions. The infectious complication rate (29/482) was 6%. Mean length of patency was 3.1 years for autogenous wrist fistula, 2.6 years for elbow fistula, 1.9 years for forearm loop PTFE, 2.1 years for straight forearm PTFE, 1.6 years for femoral popliteal PTFE, and 1.4 years for femoral arteriovenous loop PTFE. A vascular steal syndrome occurred in 8% of patients with autogenous elbow fistulas (4/48), compared with 1.7% (2/112) of patients with wrist fistulas and 1.8% (3/166) of those with PTFE fistulas. All infected fistulas required excision, and all fistulas associated with the steal syndrome required ligation. Use of PTFE to construct permanent hemodialysis vascular access has a significantly higher incidence of thrombosis, infection, pseudoaneurysm formation, and limb loss (p less than 0.01 for all complications) and a significantly lower mean length of patency (p less than 0.0001) when compared with autogenous fistulas. Age, sex, hypertension, diabetes mellitus, and the use of perioperative antibiotics were not found to be related significantly to access complications.

Adolescent↗
PubMed1985

Tenckhoff catheter obstruction resulting from invasion by Curvularia lunata in the absence of peritonitis.

A 60-year-old black woman on continuous ambulatory peritoneal dialysis (CAPD) presented with Tenckhoff catheter malfunction. She exhibited no signs or symptoms of acute peritonitis. Darkly pigmented plaques were adherent to the inner wall of the catheter and exchange tubing focally throughout its length. Similar material was adherent to the protein coagulum in the dialysis bag. The Tenckhoff catheter and tubing were removed, and hemodialysis was initiated. Cultures of the catheter and the dialysate protein coagulum grew the saprophytic soil fungus, Curvularia lunata. Histologic examination of the catheter and tubing demonstrated penetration of each by hyphae. Catheter removal alone was sufficient to eradicate the fungus since recurrence of colonization or peritonitis has not occurred following the resumption of CAPD. Peritonitis produced by opportunistic pathogens especially fungi is increasingly common. Although Curvularia species have been implicated in pulmonary and cerebral mycetomas, allergic bronchoalveolar disease, and keratitis, they have not been reported previously to cause peritonitis or catheter malfunction in CAPD patients. Fungal invasion of CAPD catheters can produce mechanical obstruction even in the absence of peritonitis. Such colonization does not preclude resumption of chronic peritoneal dialysis at a later date.

Catheters, Indwelling↗
PubMedDate not supplied

Aplastic anemia associated with parenteral chloramphenicol: review of 10 cases, including the second case of possible increased risk with cimetidine.

A case of aplastic anemia quickly followed therapy with intravenous chloramphenicol and cimetidine and rapidly resulted in death. This is the second such case reported and the 10th case of fatal aplastic anemia complicating therapy with parenteral chloramphenicol. The patient died 19 days (and the previously reported patient 18 days) after the initiation of intravenous therapy with chloramphenicol and cimetidine; the interval from the start of treatment to death was 414 +/- 683 days (mean +/- SD) in the total of nine evaluatable cases of aplastic anemia following parenteral administration of chloramphenicol. Chloramphenicol and cimetidine, each a rare cause of aplastic anemia, should be used--separately or together--with caution. The case described herein is consistent with reports of liver disease, uremia, or bone marrow dysfunction influencing the toxicities of these drugs. The potential for aplastic anemia must be considered whenever chloramphenicol is used, regardless of the route of administration.

Anemia, Aplastic↗
PubMedDate not supplied

Opportunistic infections with Strongyloides stercoralis in renal transplantation.

Opportunistic infections with the nematode Strongyloides stercoralis occur most often in patients with impaired T lymphocyte function, including recipients of renal allografts. Occult intestinal infection can remain quiescent for more than 30 years, becoming apparent only after the initiation of immunosuppression. Pulmonary and gastrointestinal symptoms predominant as initial clinical manifestations in patients with strongyloides hyperinfection or dissemination. Although thiabendazole remains the treatment of choice for all forms of strongyloidiasis, the duration of therapy must be individualized on the basis of frequent examinations of both stool and sputum. Transplantation centers drawing patients from areas with endemic Strongyloides should evaluate potential recipients closely for occult strongyloides infection prior to initiating immunosuppressive therapy. Empiric therapy with thiabendazole should be considered for renal allograft recipients with unexplained eosinophilia and a history of travel or residence in an area with endemic Strongyloides. Prophylactic monthly administration of thiabendazole in immunocompromised patients who have survived strongyloides hyperinfection or dissemination can prevent reinfection.

Adult↗