scholarly journals Alternating-day cyclosporine and prednisone for treatment of high-risk chronic graft-v-host disease

Blood ◽  
1988 ◽  
Vol 72 (2) ◽  
pp. 555-561
Author(s):  
KM Sullivan ◽  
RP Witherspoon ◽  
R Storb ◽  
HJ Deeg ◽  
S Dahlberg ◽  
...  
Keyword(s):  
High Risk ◽  
Chronic Gvhd ◽  
Renal Dialysis ◽  
Marrow Transplant ◽  
Primary Treatment ◽  
Aseptic Necrosis ◽  
Actuarial Survival ◽  
Host Disease ◽  
Group I ◽  
Group Ii

Therapy of chronic graft-v-host disease (GVHD) has been unsatisfactory in patients with platelet counts less than 100,000/microL. Survival at 5 years after marrow transplant is only 26% in such patients treated with trimethoprim-sulfamethoxazole (TMP-SMX) and every other day with prednisone. Since October 1982, 61 patients with high-risk extensive chronic GVHD were treated with a new alternating-day regimen of prednisone (1 mg/kg every other day) and oral cyclosporine (6 mg/kg every 12 hours every other day) with one double-strength TMP-SMX tablet twice daily. Forty patients (group I) received primary treatment of thrombocytopenic chronic GVHD (median platelet count 35 [range 7 to 87] x 10(3)/microL). Twenty-one patients (group II) received salvage treatment after failing initial prednisone +/- azathioprine. Twenty-one patients in group I and 15 in group II survive with a minimum of 2 years and a median of 3.7 years follow-up. At 4 years after transplant, actuarial survival is 51% (group I) and 67% (group II). Causes of death included interstitial pneumonia (six), relapse (five), GVHD without infection (five), infection (four), organ failure (three), and hemorrhage (two). Mortality increased with the progressive type onset of chronic GVHD and treatment failure. Toxicity included hypertension (13), nephrotoxicity (nine), nausea (seven), aseptic necrosis (five), neurologic abnormalities (four), and diabetes (three). Median cyclosporine levels at four and 36 hours were 296 and 64 ng/mL, respectively. Four patients required permanent discontinuation of cyclosporine, but none required renal dialysis. Karnofsky performance scores for 25 survivors are 90% to 100%, scores for six survivors are 70% to 89%, and scores for five survivors are less than 70%. Alternating-day cyclosporine and prednisone has acceptable toxicity and appears to improve survival in patients with high-risk chronic GVHD.

scholarly journals Alternating-day cyclosporine and prednisone for treatment of high-risk chronic graft-v-host disease

Blood ◽  
1988 ◽  
Vol 72 (2) ◽  
pp. 555-561 ◽  
Author(s):  
KM Sullivan ◽  
RP Witherspoon ◽  
R Storb ◽  
HJ Deeg ◽  
S Dahlberg ◽  
...  
Keyword(s):  
High Risk ◽  
Chronic Gvhd ◽  
Renal Dialysis ◽  
Marrow Transplant ◽  
Primary Treatment ◽  
Aseptic Necrosis ◽  
Actuarial Survival ◽  
Host Disease ◽  
Group I ◽  
Group Ii

Abstract Therapy of chronic graft-v-host disease (GVHD) has been unsatisfactory in patients with platelet counts less than 100,000/microL. Survival at 5 years after marrow transplant is only 26% in such patients treated with trimethoprim-sulfamethoxazole (TMP-SMX) and every other day with prednisone. Since October 1982, 61 patients with high-risk extensive chronic GVHD were treated with a new alternating-day regimen of prednisone (1 mg/kg every other day) and oral cyclosporine (6 mg/kg every 12 hours every other day) with one double-strength TMP-SMX tablet twice daily. Forty patients (group I) received primary treatment of thrombocytopenic chronic GVHD (median platelet count 35 [range 7 to 87] x 10(3)/microL). Twenty-one patients (group II) received salvage treatment after failing initial prednisone +/- azathioprine. Twenty-one patients in group I and 15 in group II survive with a minimum of 2 years and a median of 3.7 years follow-up. At 4 years after transplant, actuarial survival is 51% (group I) and 67% (group II). Causes of death included interstitial pneumonia (six), relapse (five), GVHD without infection (five), infection (four), organ failure (three), and hemorrhage (two). Mortality increased with the progressive type onset of chronic GVHD and treatment failure. Toxicity included hypertension (13), nephrotoxicity (nine), nausea (seven), aseptic necrosis (five), neurologic abnormalities (four), and diabetes (three). Median cyclosporine levels at four and 36 hours were 296 and 64 ng/mL, respectively. Four patients required permanent discontinuation of cyclosporine, but none required renal dialysis. Karnofsky performance scores for 25 survivors are 90% to 100%, scores for six survivors are 70% to 89%, and scores for five survivors are less than 70%. Alternating-day cyclosporine and prednisone has acceptable toxicity and appears to improve survival in patients with high-risk chronic GVHD.

Prednisone and azathioprine compared with prednisone and placebo for treatment of chronic graft-v-host disease: prognostic influence of prolonged thrombocytopenia after allogeneic marrow transplantation

Blood ◽  
1988 ◽  
Vol 72 (2) ◽  
pp. 546-554 ◽  
Author(s):  
KM Sullivan ◽  
RP Witherspoon ◽  
R Storb ◽  
P Weiden ◽  
N Flournoy ◽  
...  
Keyword(s):  
Chronic Gvhd ◽  
Aseptic Necrosis ◽  
Actuarial Survival ◽  
Double Blind ◽  
Host Disease ◽  
Group Iii ◽  
Group I ◽  
Group Ii ◽  
Recurrent Malignancy ◽  
Blind Comparison

We conducted a randomized, double-blind comparison of prednisone and placebo (group I) v prednisone and azathioprine (1.5 mg/kg/day) (group II) as early treatment of extensive chronic graft-v-host disease (GVHD). Patients with platelet counts less than 100,000/microL were placed into therapy with prednisone alone (group III). All three groups received identical doses of prednisone (1 mg/kg every other day) and one double-strength trimethoprim-sulfamethoxazole (TMP-SMX) tablet twice daily. Between January 1980 and December 1983, 179 previously untreated patients were enrolled and 164 were evaluable. Patients randomized to group I (n = 63) and group II (n = 63) were well matched for prognostic factors; those placed into group III (n = 38) had more frequent acute GVHD and progressive onset of chronic GVHD. Median duration of therapy was 2 years. Complications included diabetes (5%), aseptic necrosis (5%) and infection. For groups I, II, and III, the respective incidence of infection was disseminated varicella, 11%, 24%, 34%; bacteremia, 6%, 11%, 34%; and interstitial pneumonia, 5%, 14%, 18%. Recurrent malignancy was the most frequent cause of death and did not differ significantly across the groups. Nonrelapse mortality, however, did differ: 21% in group I, 40% in group II, and 58% in group III (I v II, P = .003; I v III, P = .001). Forty patients in group I, 30 in group II, and 10 in group III survive with a minimum follow-up of 3.8 years. Karnofsky performance scores for 68 survivors are 90% to 100%, scores for seven survivors are 70% to 89% and scores for five survivors are less than 70%. Actuarial survival at 5 years after transplant is 61% in group I, 47% in group II, and 26% in group III (I v II, P = .03; I v III, P = .0001). Treatment with prednisone alone results in fewer infections and better survival than prednisone and azathioprine in standard-risk chronic GVHD. Treatment with prednisone alone is less effective in high-risk patients with thrombocytopenia, and other strategies are required.

scholarly journals Prednisone and azathioprine compared with prednisone and placebo for treatment of chronic graft-v-host disease: prognostic influence of prolonged thrombocytopenia after allogeneic marrow transplantation

Blood ◽  
1988 ◽  
Vol 72 (2) ◽  
pp. 546-554 ◽  
Author(s):  
KM Sullivan ◽  
RP Witherspoon ◽  
R Storb ◽  
P Weiden ◽  
N Flournoy ◽  
...  
Keyword(s):  
Chronic Gvhd ◽  
Aseptic Necrosis ◽  
Actuarial Survival ◽  
Double Blind ◽  
Host Disease ◽  
Group Iii ◽  
Group I ◽  
Group Ii ◽  
Recurrent Malignancy ◽  
Blind Comparison

Abstract We conducted a randomized, double-blind comparison of prednisone and placebo (group I) v prednisone and azathioprine (1.5 mg/kg/day) (group II) as early treatment of extensive chronic graft-v-host disease (GVHD). Patients with platelet counts less than 100,000/microL were placed into therapy with prednisone alone (group III). All three groups received identical doses of prednisone (1 mg/kg every other day) and one double-strength trimethoprim-sulfamethoxazole (TMP-SMX) tablet twice daily. Between January 1980 and December 1983, 179 previously untreated patients were enrolled and 164 were evaluable. Patients randomized to group I (n = 63) and group II (n = 63) were well matched for prognostic factors; those placed into group III (n = 38) had more frequent acute GVHD and progressive onset of chronic GVHD. Median duration of therapy was 2 years. Complications included diabetes (5%), aseptic necrosis (5%) and infection. For groups I, II, and III, the respective incidence of infection was disseminated varicella, 11%, 24%, 34%; bacteremia, 6%, 11%, 34%; and interstitial pneumonia, 5%, 14%, 18%. Recurrent malignancy was the most frequent cause of death and did not differ significantly across the groups. Nonrelapse mortality, however, did differ: 21% in group I, 40% in group II, and 58% in group III (I v II, P = .003; I v III, P = .001). Forty patients in group I, 30 in group II, and 10 in group III survive with a minimum follow-up of 3.8 years. Karnofsky performance scores for 68 survivors are 90% to 100%, scores for seven survivors are 70% to 89% and scores for five survivors are less than 70%. Actuarial survival at 5 years after transplant is 61% in group I, 47% in group II, and 26% in group III (I v II, P = .03; I v III, P = .0001). Treatment with prednisone alone results in fewer infections and better survival than prednisone and azathioprine in standard-risk chronic GVHD. Treatment with prednisone alone is less effective in high-risk patients with thrombocytopenia, and other strategies are required.

Donor CD34+ Cell Chimerism at Day 28 and Chronic Graft-Versus-Host Disease (GvHD) but Not High-Risk Cytogenetics Influence Outcome of Allogeneic Hematopoetic Cell Transplantation (HCT) Following Reduced Intensity Conditioning (RIC) in Patients with AML and MDS.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 547-547 ◽  
Author(s):  
Haifa K. Al-Ali ◽  
Claudia Nehring ◽  
Rainer Krahl ◽  
Cornelia Becker ◽  
Sabine Leiblein ◽  
...  
Keyword(s):  
Risk Factors ◽  
T Cell ◽  
High Risk ◽  
Chronic Gvhd ◽  
Disease Free Survival ◽  
Group I ◽  
Cd34 Cells ◽  
Patients At Risk ◽  
Group Ii

Abstract HCT after RIC is used increasingly to treat older or infirm patients with AML or MDS. In the current analysis we looked for risk factors influencing outcome including cytogenetics, kinetics of donor CD34+ and T-cell chimerism (CC). Patients and methods: From July 1998 - December 2005, 119 consecutive patients [66 m/53 f; median age 60 (range 21–74) years] with AML (n=99; 83%) and high-risk MDS (n=20; 17%) were treated within the OSHO AML studies before HCT. Seventy (59%) of the patients had intermediate-risk cytogenetics and 44 (37%) high-risk cytogenetics. Patients were either in CR1 (n= 66; 55%), CR2 (n=18; 15%), >CR2 (n=28; 24%), or were untreated (n=7; 6%) at transplant. HCT was performed from matched related (n= 33; 28%) and matched unrelated (n= 86; 72%) donors after RIC (200cGy TBI + fludarabine 30 mg/m2/day on 3 consecutive days) and followed by immunosuppression with cyclosporine and mycophenolate mofetil. Marrow donor chimerism was determined in T-, and CD34+−cells at days (d) 28, 56, 84, and thereafter at 3 month intervals using either XY chromosome FISH in gender mismatched, or PCR based analysis of polymorphic micro satellite regions in gender matched HCT. Results: Engraftment was documented in 112 (94%) of the 119 patients. Survival (OS), disease free survival (DFS), relapse incidence (RI), and non-relapse mortality (NRM) of engrafted patients was 40%, 38%, 46%, and 30% at 3 years respectively. In multivariate analysis, only >90% donor CD34+ CC at d 28, chronic GvHD, and CR1, but not cytogenetic risk factors were associated with an improved OS and DFS. Patients with >90% donor CD34+ CC at d 28 (group I) had an OS of 50% compared to 9% in patients with donor CD34+ CC <90% (group II) (p=0.002). Accordingly, RI in group I was 35% compared to 85% in group II (p<0.0001). Again, donor CD34+ CC at d 28 but neither donor T-cell chimerism nor high-risk cytogenetics correlated with relapse. Relapse occurred in 41/109 (38%) patients at a median of 121 d. All patients (n=19) with haematological relapse within 100 days post transplant died despite reduction/withdrawal of immunosuppression. Of the 22 patients with later relapse, six went into permanent complete remission by reduction/withdrawal of immunosuppression. A decrease of CD34+ chimerism was detected in a further six patients and all responded to a decrease in immunosuppression. The incidence of acute (grades ≥ I) and chronic (limited and extensive) GvHD was 50%, and 55% respectively. OS was 10%, 46%, and 62% for patients with no GvHD (A), acute GvHD only (B), and chronic GvHD (C) (p=0.0001). DFS for A, B, C was 20%, 38%, and 55% respectively ((p=0.0001). RI was highest for A (72%) compared to B (49%) and C (25%) (p<0.0001). Conclusions: HCT after RIC offers long-term OS and DFS in AML/MDS even in patients with high-risk cytogenetics. CR1, donor CD34+ CC >90% at d 28 and chronic GvHD correlate with an improved outcome and decreased relapse incidence. Careful monitoring of donor CD34+ CC can identify patients at risk for relapse, thereby allowing early immunmodulation.

Factors Influencing Relapse after Allogeneic Hematopoietic Cell Transplantation (HCT) Following Reduced Intensity Conditioning (RIC) in Patients with AML and MDS.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1654-1654
Author(s):  
Haifa K. Al-Ali ◽  
Claudia Nehring ◽  
Rainer Krahl ◽  
Cornelia Becker ◽  
Sabine Leiblein ◽  
...  
Keyword(s):  
High Risk ◽  
Hematopoietic Cell Transplantation ◽  
Bone Marrow Cells ◽  
Negative Impact ◽  
Chronic Gvhd ◽  
Therapeutic Interventions ◽  
Entire Cohort ◽  
Factors Influencing ◽  
Group I ◽  
Group Ii

Abstract Relapse (RI) after HCT especially after RIC remains the major risk factor affecting outcome. Factors influencing relapse in patients (pts) with AML/MDS undergoing HCT after RIC were analysed. Patients and methods: From July, 1998- December, 2006, 156 consecutive pts [86 m/70 f; median age 61 (range 21–75) years (y)] with AML, n=138 (88%) and high-risk MDS, n=18 (12%) treated within the OSHO studies received HCT after RIC [2Gy TBI ± fludarabine 30 mg/m2/day on 3 days] followed by immunosuppression with mycophenolate mofetil and cyclosporine. Donors were MRD in 40 (26%) and MUD in 116 (74%) pts. Stage of disease was CR1, n= 99 (63%), CR2, n=18 (12%), and &gt;CR2, n=39 (25%). Cytog. was intermediate-, and high-risk in 100 (64%), and 49 (31%) respectively. DCC in unsorted and flow-sorted T (CD3+)-, and CD34+-bone marrow cells at days (d) 28, 56, 84, and at 3 months interval thereafter was monitored by FISH for the XY chromosome in gender mismatched or PCR for polymorphic micro satellite regions in gender matched HCT. Results: 141 (90%) pts engrafted. OS, DFS, RI, and NRM at 5 y were 38%, 36%, 47%, and 30% respectively. In multivariate analysis, RI for pts in CR1 was significantly lower compared to pts transplanted beyond CR1 (p=0.005). For the entire cohort, type of donor had no influence on RI but for pts in CR1, RI with MUD and MRD was 29% and 60% respectively (p=0.008). NRM did not correlate with the type of donor. Interestingly, high-risk cytog. had no negative impact on outcome. OS, DFS, and RI for pts with high-risk cytog. transplanted in CR1 were 43%, 48%, and 38% respectively compared to 38%, 43%, and 45% for pts with intermediate-risk cytog. (p=0.65). Incidence of acute (grade I-IV) and chronic (limited and extensive) GvHD was 55%, and 58% respectively. GvHD correlated with an improved OS (p=0.0003) and DFS (p=0.003) but was not associated with a higher NRM (p=0.1) compared to pts with no GvHD. Also, RI was markedly influenced by GvHD (p=0.002). RI in pts with no GvHD (n=42), acute GvHD only (n=34), limited chronic GvHD (n=33), and extensive chronic GvHD (n=30) was 63%, 41%, 29%, and 18% respectively. In pts with chronic GvHD, RI was significantly lower compared to pts with no GvHD (p&lt;0.0001). Further, CD34+ DCC ≥90% at d 28 strongly correlated with outcome at 5 y. OS and DFS in pts with CD34+ DCC ≥90% at d 28 (group I) were 50%, and 47% respectively compared to pts with CD34+ DCC &lt;90% at d 28 (group II) (OS 20%, DFS 15%) (p&lt;0.0001). CD34+ DCC ≥90% at d 28 was highly predictive of early (≤100 d) and late (&gt;100 d) haematological relapse. Probability of RI in group I was 29% compared to 76% in group II (p&lt;0.0001). On the other hand, DCC in unsorted- and CD3+-cells at d 28 did not correlate with OS, DFS nor predict relapse. Conclusions: HCT after RIC offers long-term OS and DFS in AML/MDS pts. RI was lowest in pts transplanted from MUD in CR1. High-risk cytog. had no negative impact on RI. GvHD correlated with an improved outcome. CD34+ DCC ≥90% at d 28 was highly predictive of relapse after HCT. Careful monitoring of CD34+ DCC could identify pts at risk of relapse and might allow therapeutic interventions as tapering of immunosuppression.

scholarly journals Assessment of fetal lung maturity using analysis of amniotic fluid from ewes that gave birth prematurely and at term

2020 ◽  
Vol 40 (12) ◽  
pp. 1039-1047
Author(s):  
Natália Cristina de Souza ◽  
Fernanda Bovino ◽  
Larissa Gabriella Avilla ◽  
Maurício Deschk ◽  
Jefferson F. Alcindo ◽  
...  
Keyword(s):  
High Risk ◽  
Cesarean Section ◽  
Amniotic Fluid ◽  
Lamellar Body ◽  
Normal Delivery ◽  
Group Iii ◽  
Risk Pregnancy ◽  
Group I ◽  
Group Ii ◽  
Lung Maturity

Abstract: The aim of this study was to evaluate the lung maturity of premature and full-term lambs by analyzing amniotic fluid using the following methods: Clements test, Nile blue cytology test, hematoxylin-Shorr stain, lamellar body count, and radiographic tests. The use of these methods is intended to identify high-risk newborns and provide immediate clinical intervention after birth. Altogether, 56 animals (24 ewes and 32 lambs) were included in the study and divided into 3 groups. Group I consisted of 8 ewes that were at approximately 145 days of gestation; this group delivered 10 lambs naturally. Group II consisted of 8 ewes that were at 138 days’ gestation; this group delivered 11 lambs by cesarean section. Group III consisted of 8 ewes at 138 days’ gestation; this group was administered intramuscular dexamethasone (16mg/animal) 36 hours prior to a cesarean section. Group III delivered11 lambs. Cytological tests were performed using a microscope with a maximum magnification of 1000x, while the Clements test was visually observed by one of the researchers. Amnioticfluid lamellar body counts were measured using transmission electron microscopy. Among the staining methods, hematoxylin-Shorr was reliable, and Group III had a greater number of orangeophilic cells when compared to Group II, probably due to corticoid administration. The Clements test showed pulmonary maturity in approximately 20% of Group I lambs and Group II showed 9.1% of bubbles; however, Group III had the highest pulmonary maturity percentage (36.4%). The lamellar bodies were measured, and all groups had sizes between 0.019 and 0.590μm. Radiographic evaluation revealed that the majority of lambs presented some level of pulmonary radiodensity, indicating an acinar pattern at birth. These results are in line with the expectations of each group. We found that the normal group showed greater pulmonary maturity, whereas Group II presented pulmonary immaturity, which is expected because this group comprised lambs born prematurely and Group III showed pulmonary maturity almost comparable to the normal delivery group (Group I). This is due to the fact that although these animals are premature, the use of dexamethasone helped in pulmonary maturation. Therefore, these pulmonary maturity tests are considered effective when more than one technique is used and can be used routinely in the care of a pregnant ewe in labor, where a simple collection of amniotic fluid can predict a high-risk pregnancy and alert the veterinarian if the newborn needs intensive supportive treatment.

Effectiveness of pregravid preparation in women of high infectious risk

2018 ◽  
pp. 31-35
Author(s):  
T.G. Romanenko ◽  
◽  
O.M. Sulimenko ◽  
Keyword(s):  
High Risk ◽  
Bacterial Vaginosis ◽  
Pregnant Women ◽  
Risk Group ◽  
Intrauterine Infection ◽  
Vaginal Candidiasis ◽  
Placental Dysfunction ◽  
Infectious Risk ◽  
Group I ◽  
Group Ii

The article presents the results of the effectiveness of the combined antimicrobial drug Guinex Forte, the effect of which is caused by metronidazole and miconazole, and the Orgil tablets at the stage of pregravid preparation in women of high-risk group, with regard to the development of placental insufficiency of infectious genesis and intrauterine infection. The objective: is to demonstrate the effectiveness of pregravid preparation for the normalization of vaginal biocenosis in pregnant women of high infectious risk. Materials and methods. 150 pregnant women were investigated, of which 100 with a high risk of infectious risk for placental dysfunction and intrauterine infection: Group I – 50 pregnant women who did not undergo pregravid preparation; Group II – 50 pregnant women who planned pregnancy and conducted pregravid preparation for prevention and treatment of bacterial vaginosis and vaginal candidiasis; Control group consisted of 50 pregnant women who gave birth again, without obstetrical and extragenital pathology in history. per vaginum. Results. In pregnant women in Group II, an intermediate type of dysbiosis was 1.2 times less likely than in pregnant women of group I, and vice versa, normocenosis was achieved 9.7 times more often in pregnant women who received pregravid preparation. After the therapy in the pregravid period, in pregnant women of group II in the first trimester of pregnancy quantitative and qualitative indices of biocenosis of the vagina were approaching, in most cases, to normal. In general, the spectrum of the microflora decreased from 21 to 14 species due to the reduction of pathogenic forms of staphylococci, streptococci, enterobacteria, E. coli, klebsiela, cornebacteria and clostridia. In patients of group II, the concentration of representatives of resident flora increased (lactobacillus Lg 5.06±0.7 CFU / ml and bifidobacterium-Lg 4.4±0.6 CFU / ml) and close to normal. Conclusion. Our proposed scheme of therapy and prevention of dysbiotic conditions in the pregravid period, in women of high infectious risk group led to a decrease in bacterial contamination of maternity paths of pregnant women in group II, which contributes to the restoration of vaginal microbiocenosis and positively affects the course of pregnancy, the condition of the fetus and the newborn. Key words: pregravid preparation, bacterial vaginosis, vulvovaginal candidiasis, placental dysfunction of infectious genesis, intrauterine infection.

scholarly journals COMPARATIVE STUDY BETWEEN THE EFFECT OF HISTAMINE RECEPTOR ANTAGONISTS OF TYPE II (FAMOTIDINE) AND PROTON PUMP INHIBITORS (OMEPRAZOLE) ON THE EFFICACY OF CALCIUM CARBONATE AS PHOSPHATE BINDER IN HAEMODIALYSIS PATIENT

2017 ◽  
Vol 9 (8) ◽  
pp. 10
Author(s):  
Hossam Aboelyazeed ◽  
Sahar El-haggar ◽  
Kamal Okasha
Keyword(s):  
Calcium Carbonate ◽  
Serum Calcium ◽  
Phosphate Binder ◽  
Renal Dialysis ◽  
University Hospital ◽  
Control Group ◽  
Group Iii ◽  
Group I ◽  
Group Ii ◽  
Pre Treatment

Objective: The purpose of this study was to compare the effect of famotidine versus omeprazole on the efficacy of calcium carbonate as a phosphate binder in the hemodialysis patient.Methods: From February 2014 to June 2014 a total number of 64 patients of both sexes were recruited from the department of renal dialysis, Tanta University Hospital, Egypt. Patients categorized into 3 groups. Group I (control group) consisted of 20 Patients (10) females and (10) males take calcium carbonate (caco3) (2.5–4 g/d) only, Group II consisted of 21 Patients (13) females and (8) males take the same dose of caco3 with famotidine 10 mg/d and Group III consisted of 23 Patients (8) females and (15) male take the same dose caco3 with omeprazole 20 mg/d.Results: All data are expressed as the mean±SD. Group II showed a significant increase (p<0.05) in serum phosphorus at 3rd mo with significant decreased (p<0.05) in serum calcium comparing with pre-treatment. Group III showed no significant change (p>0.05) in serum calcium, phosphorus and parathyroid hormone (PTH) comparing with pre-treatment. Both groups (II and III) showed a significant decrease in alkaline phosphatase (ALP) (p<0.05).Conclusion: Co-administration of famotidine with calcium carbonate aggravates hyperphosphatemia and this may increase the incidence of complications. The efficacy of calcium carbonate as a phosphate binder was not affected by co-administration of omeprazole.

A Review of Peritonitis Episodes that Caused Interruption of CAPD

1983 ◽  
Vol 3 (3_suppl) ◽  
pp. 11-13 ◽  
Author(s):  
George Wu
Keyword(s):  
High Risk ◽  
Barium Enema ◽  
Fecal Peritonitis ◽  
Polycystic Kidneys ◽  
Average Population ◽  
Group I ◽  
Severe Peritonitis ◽  
Group Ii ◽  
Esrd Patients

In 49 of 508 ESRD patients, CAPD failed because of peritonitis, constituting the leading cause of such failure. These patients were divided into two groups (I and II) according to frequency of peritonitis. Group I patients (n = 25) had frequent, recurrent peritonitis (one episode every 2.6 months) whereas, among Group II patients, unusual or severe peritonitis (fecal, fungal and TB) was more common -in the latter the frequency of peritonitis was similar to that in the average population. Fecal peritonitis constituted 19% of all the episodes which led to interruption of CAPD; most of these cases seemed to be the result of diverticulitis. We believe that patients at particular risk of developing diverticulosis i.e., those older than 50 years and those with polycystic kidneys, should have a barium enema; if extensive diverticulosis is found, they should be considered to be at high risk for development of diverticulitis and fecal peritonitis. Even though the decreasing incidence of peritonitis leads to an overall decrease in peritonitis mortality and CAPD failure, once peritonitis develops, patients have the same risk of dying or failing now, as they had five years ago. For this reason we must undertake further studies in order to improve our management of these patients.

scholarly journals Predictors of death from chronic graft-versus-host disease after bone marrow transplantation

Blood ◽  
1989 ◽  
Vol 74 (4) ◽  
pp. 1428-1435 ◽  
Author(s):  
JR Wingard ◽  
S Piantadosi ◽  
GB Vogelsang ◽  
ER Farmer ◽  
DA Jabs ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Marrow ◽  
Bone Marrow Transplantation ◽  
Marrow Transplantation ◽  
Acute Gvhd ◽  
Chronic Gvhd ◽  
Hazard Ratio ◽  
Actuarial Survival ◽  
Host Disease ◽  
Late Morbidity

Abstract Chronic graft-v-host disease (chronic GVHD) is a frequent cause of late morbidity and death after bone marrow transplantation (BMT). The actuarial survival after onset of chronic GVHD in 85 patients was 42% (95%Cl = 29%, 54%) at 10 years. Baseline characteristics present at the onset of chronic GVHD (before therapy) in 85 patients were reviewed to determine which were risk factors for death. In a multivariate proportional hazards analysis, three baseline factors emerged as independent predictors of death: progressive presentation (chronic GVHD following acute GVHD without resolution of acute GVHD; hazard ratio of 4.1, 95% Cl = 2.1 to 7.8), lichenoid changes on skin histology (hazard ratio of 2.2, 95% Cl = 1.1 to 4.3), and elevation of serum bilirubin greater than 1.2 mg/dL (hazard ratio = 2.1, 95% Cl = 1.1 to 4.1). Actuarial survival of 23 chronic GVHD patients with none of these risk factors was 70% at 6 years (95% Cl = 38%, 88%). Thirty-eight patients with one of these risk factors had a projected 6-year survival of 43% (95% Cl = 21%, 63%). The 29 patients with any combination of two or more of these factors had a projected 6-year survival of only 20% (95% Cl = 8%, 37%). Identification of baseline risk factors should facilitate design of trials of chronic GVHD therapies and assignment of high-risk patients to more aggressive innovative therapeutic regimens.

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