New approaches to the diagnosis, prevention and treatment of cytomegalovirus infection after transplantation

Article Abstract:

A state of balance must exist between a transplanted organ and the person receiving it. This balance begins with the actual transplant, and is continued throughout the process of controlling transplant rejection by incremental adjustments in immune suppression medications. Infection remains one of the major complications of organ transplant, and a significant cause of morbidity and death. An important challenge for the future is to be able to separate the elements of immune suppression so that those that complicate graft acceptance can be controlled without reducing the patient's natural defenses against infection. This ideal immune suppression would involve very selective host tolerance to transplant donor antigens. Progress has been made in treating fungal and bacterial infections, but viral infections remain a threat to transplant patients. Infection with cytomegalovirus (a herpes type virus) has had an impact on organ transplant. These infections, which are initially mild and involve complaints of fever, malaise, lethargy and muscle pains, can evolve into fatal illness. Cytomegalovirus infections (CMV) usually occur in the first few months after transplant, the time corresponding to peak immune suppression treatment. Diagnosis is based on physical signs and symptoms. Recent improvements in diagnostic testing are permitting early diagnosis. Prophylaxis and treatment of CMV infection involve the use of antiviral agents specifically directed toward CMV. Administration of acyclovir after transplant may reduce the incidence CMV disease. Acyclovir is not particularly effective in treating CMV disease. Gancyclovir may be effective, but it must be given intravenously. Another new drug is trisodium phosphonoformate, which may be useful if drug resistance occurs. This drug is toxic to the kidney and must be used with caution. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Physiological aspects, Drug therapy, Cytomegalovirus infections, Graft versus host reaction, Transplantation immunology, Graft vs. host disease, Host-virus relationships

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Immediate versus delayed shoulder exercises after axillary lymph node dissection

Article Abstract:

The most common cancer in women is breast cancer, occurring in about 9 percent of the female population. Treatment for this cancer may include breast resection (removal of all or a significant portion of the breast) and dissection of the lymph nodes of the axilla (arm pit). The most common postoperative complication is development of lymphedema (accumulation of lymph in the soft tissues); inadequate function of the shoulder may also result. Postoperative care for these complications is controversial. Some physicians recommend shoulder exercises immediately after surgery, but others suggest that these early exercises reduce the desired drainage from the wound. In order to evaluate the effects of early exercise, a prospective randomized study was undertaken of 144 patients with breast cancer. All patients, those having modified radical mastectomy as well as those having breast conserving treatment, underwent axillary lymph node dissection. One group of 78 women began active shoulder exercises one day following surgery; the second group, 66 women, began exercises on the eighth postoperative day. Shoulder function was measured at the time of discharge and then at one and six months after surgery. Comparison of the two groups at six months revealed no difference in the duration and volume of wound drainage, wound complication rates or shoulder function. It is concluded that early or delayed shoulder exercise does not influence the outcome in terms of shoulder function in women after surgery for breast cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Breast cancer, Physical therapy, Lymph nodes, Mastectomy, Lymph node excision

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Ranitidine for prevention of postoperative suppression of delayed hypersensitivity

Article Abstract:

The immune response to several proteins (antigens) causing an allergic reaction, measured by a skin test, was studied in 20 patients undergoing major abdominal surgery and 20 subjects not undergoing surgery (controls). Both groups were either given an allergy blocking drug (ranitidine) or not given the drug treatment. Skin tests of both groups were made two days before and one day after. After surgery, the size of the area affected by the allergic reaction was smaller for each of the 10 patients who did not receive ranitidine. Nine of the 10 patients receiving the drug showed an increased response to the test proteins. The skin test results in all controls were similar. Ranitidine did not increase the response to the skin test proteins in the controls. The authors conclude that the ability of such compounds to reverse the known impairment of the immune system, and the increased risk of infection following surgery, should be explored.

Prevention, Immune response, Abdomen, Laparotomy, Delayed hypersensitivity, Ranitidine

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