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Biomedical subjects

L Dowdy

Publications and source records attributed to L Dowdy.

9 recordsLinked to original sources
PubMed2003

Bacterial infections after intestine and multivisceral transplantation.

BACKGROUND: The frequency of bacterial infections (BI) in intestinal transplant (IT) patients is high with sepsis being the leading cause of death after this procedure. We herein report our experience with major BI to ascertain the incidence, microbiological and clinical factors, risk factors and outcome. MATERIALS AND METHODS: 124 patients (72 children and 52 adults) received 135 grafts: namely, 39 isolated intestine, 33 liver-intestine and 63 multivisceral. Only major BI were considered, namely, those associated with serious morbidity/mortality requiring specific therapy. Patient data were retrieved from computerized databases, flow-charts, and medical records. RESULTS: 92.7% patients showed BI. There were 327 episodes, representing 2.6 episodes/patient (2.8/patients with infection): 193 episodes of bacteremia (1.7/patient with BI) including 29.5% due to catheter related sepsis, 16.5% from abdominal source, 5.7% from respiratory origin and 4.1% from the wound. The organ locations includes 46 respiratory infections, 33 intraabdominal abscesses or infected fluid collections, 8 diffuse peritonitis, 34 wound infections and other miscellaneous sites: empyema, soft tissue infections, cholangitis em leader etc. Median time of infection was nine days after surgery (mean 22+/-3 days), with 67.7% patients having at least one BI before the end of the first month. Infection was present in 76.2% of the 63 deceased patients. An infectious episode during month 1, a clinically manifest abdominal infection and a positive intraabdominal culture had negative impacts on patient survival. CONCLUSIONS: BI are common and early complications after IT. The high rate of bacteremia, line sepsis and abdominal and respiratory infections reflect the recipient's condition, with chronic deterioration superimposed with the effects of prolonged abdominal visceral surgery.

Adult↗
PubMed2001

Genitourinary tuberculosis after renal transplantation: report of 3 cases and review.

Mycobacterium tuberculosis infection of the genitourinary tract is an uncommon disease in renal transplant recipients and presentation is atypical. Genitourinary tuberculosis is associated with graft rejection, and this diagnosis should be considered for renal transplant recipients with unexplained fever and constitutional symptoms.

Adolescent↗
PubMed1999

Impulsive and premeditated aggression: a factor analysis of self-reported acts.

Although aggression research in general has been hampered by a lack of objective measurements of aggressive acts, two types of aggressive acts, impulsive vs. premeditated, have been studied extensively in recent years. These two types of aggression have been primarily measured by structured or semi-structured interviews. The current study was designed to assess the construct validity of these two types of aggression using a self-report questionnaire which included items gleaned from the content of interviews used in past studies. For this study, 216 college students assessed their own aggressive acts rather than answering general questions about aggression. The students were not significantly different from normative sample groups on self-report measures of impulsiveness, aggression, and anger/hostility. A PCA factor analysis with a promax rotation of the items on the self-report questionnaire identified four factors: impulsive aggression; mood on the day the act occurred; premeditated aggression; and agitation. Thus, impulsive and premeditated aggression are independent constructs which exist in varying degrees among these 'normal' persons in a non-clinical sample. Impulsive aggression was characterized in part by feelings of remorse following the acts and by thought confusion. Premeditated aggression was related to social gain and dominance.

Adult↗
PubMed1998

Cerebral mucormycosis after liver transplantation: a case report.

A fatal case of cerebral mucormycosis occurring shortly after liver transplantation is described. The patient was a 32-yr-old male with advanced end-stage liver disease manifested by tense ascites, spontaneous bacterial peritonitis, deepening jaundice and anuria requiring hemodialysis. The 3rd day after successful liver transplantation the patient developed acute respiratory failure, then focal motor signs. Computed tomography showed fluid in the left maxillary sinus, partial opacification of the ethmoid and sphenoid sinuses, and diffuse low density lesions in both cerebral hemispheres. Despite treatment for cerebritis and cerebral edema, the patient's pupils became fixed and dilated, and brain death was declared. Autopsy revealed mucor sinusitis and cerebritis. Mucormycosis is an opportunistic fungal infection occurring in patients with diabetic ketoacidosis, malignancy, or immunodeficiency, and in those receiving wide-spectrum antibiotics, corticosteroids, or cytotoxic therapy. Mucor most frequently involves the face, rhinocerebral disease predominating. These infections are difficult to treat, but are curable with aggressive and frequent surgical debridement, discontinuation or reduction of immunosuppressive therapy and amphotericin. The diagnosis of mucormycosis is very difficult to make in cases such as the present one, in which the typical presentation and classical signs are not present. A high index of suspicion based on identified risk factors may assist in more rapid diagnosis of this life-threatening mycosis.

Adult↗
PubMed1996

Destructive allograft fungal arteritis following simultaneous pancreas-kidney transplantation.

Fungal arteritis of the Y graft used to revascularize the whole pancreas graft developed in 2 recipients of simultaneous pancreas-kidney transplant that were performed within 36 hr of each other. The vascular infection became manifest 6-7 days following transplantation. In both patients, the vasculitis culminated in an arterial rupture that required immediate operative intervention. This compromise of the Y grafts contributed to loss of both pancreatic grafts and necessitated vascular reconstruction to reperfuse the lower extremity. To date, both patients continue to experience normal kidney transplant function.

Adult↗
PubMedDate not supplied

Bacterial infections after intestine and multivisceral transplantation. The experience of the University of Miami (1994-2001).

BACKGROUND/AIMS: Bacterial infections (BI) are frequent after intestinal transplantation (ITx). Bacteremia, intraabdominal and respiratory infections are the leading forms. The objective of this study is to analyze the occurrence, determinants and outcome of BI. METHODOLOGY: One hundred and twenty-four patients with ITx (39 isolated, 33 liver-intestine, 63 multivisceral). Only major BI were considered, including bacteremia, pneumonia, intraabdominal infections, severe wound infections. RESULTS: BI occurred in 92.7% of patients during follow-up, with an average of 2.9 episodes per patient. Bacteremia was the commonest picture (1.7 per patient). More than 80% of patients had a BI before the end of the second month. Multivariate analysis showed that the presence of BI was higher during the first 2 months after Itx in patients hospitalized before Tx [p=0.029, odds ratio (OR) 5.4] and during months 3 to 6 in those treated with Zenapax (p=0.003, OR 6.2). Occurrence of BI was increased with mycophenolate mofetil treatment (p=0.045 OR 4.2). Intraabdominal infection was more frequent when reTx was needed (p=0.0178 OR 15.2), admission before Tx (p=0.034 OR 2.7), IS with MMF (p=0.004 OR 6.2) and Zenapax (p=0.026 OR 3.6). BI was the direct cause of death in 17.8% of patients, and it was present in 76.2% of patients that died. An infectious episode during the first month, a clinically manifested abdominal infection and a positive intraabdominal culture were determinants of shorter patient survival. CONCLUSIONS: BI continue to be a frequent and dreadful complication after ITx. Pretransplant patient condition, IS used and postoperative complications are crucial on BI onset and outcome.

Abdominal Abscess↗