1/11. Creutzfeldt-Jakob disease in a patient with a lyophilized dura mater graft.A 37-year-old patient with Creutzfeldt-Jakob disease (CJD) is presented, who had received a cadaveric dura matter graft 12 year before the onset of neurologic symptoms. Initial clinical presentation included cerebellar symptoms, with dementia and myoclonus developing in later stages of the disease. EEG showed diffuse slowing with sporadic triphasic periodic activity. CT was normal in the early stage but pronounced cerebral and cerebellar atrophy with widened sulci were seen on MRI in the late stage of the disease. The prion protein (PrP) gene was homozygous for valin at the polymorphic codon 129. cerebrospinal fluid analysis for 14-3-3 protein was positive. We believe that this patient is the first Croatian to acquire CJD by dural implant. Based on this case and a review of 66 cases from the literature, it is manifest that the awareness of iatrogenic transmission of CJD and adoption of preventive measures are the only effective way to stop the spread of CJD among surgically treated patients.- - - - - - - - - - ranking = 1keywords = transmission (Clic here for more details about this article) |
2/11. Tuberculosis transmitted through transplantation.Tuberculosis in solid organ transplant recipients is associated with relatively high morbidity and mortality and is often extra-pulmonary. Reactivation of dormant infection is the usual mode of acquisition with donor and nosocomial transmission occurring infrequently. We report two cases of probable donor transmitted extra-pulmonary infection where both isolates of mycobacterium tuberculosis proved to be indistinguishable using hemi-nested inverse PCR of the IS 6110 region.- - - - - - - - - - ranking = 1keywords = transmission (Clic here for more details about this article) |
3/11. Neurosurgical reconstruction with acellular cadaveric dermal matrix.Acellular cadaveric dermal matrix (ACDM) is processed from human cadaver skin (AlloDerm; life Cell Corp., Branchburg, NJ). It does not require an immediate blood supply but can transmit essential interstitial fluids for nourishment of overlying tissues. A number of neurosurgical reconstructions have required the use of tissue that fills these specifications. The material has been used most recently for reconstruction of dura during craniotomies when primary closure is not possible or harvesting from an autologous site is not available. Because ACDM is harvested from nonneurologic cadaveric tissues and because the cellular and antigenic elements have been removed from the matrix, prion diseases are not a transmission risk. We present 6 examples of previously unreported uses of ACDM for successful repair of meningomyelocele, cauda equina, encephalocele, cerebrospinal fluid fistula, and neuroma. We propose the use of ACDM as a valuable tool in neurosurgical reconstruction.- - - - - - - - - - ranking = 1keywords = transmission (Clic here for more details about this article) |
4/11. Creutzfeldt-Jakob disease acquired via a dural graft: failure of therapy with quinacrine and chlorpromazine.BACKGROUND: Accidental transmission of Creutzfeldt-Jakob disease (CJD) has been reported after neurosurgical interventions, use of intracerebral electrodes, corneal transplants, and after the administration of human-derived hormones. Acquired CJD has also been documented after dural grafting with tissues of human cadaver origin. At present, quinacrine and chlorpromazine are being investigated for the treatment of sporadic CJD, with the hope of offering an effective treatment of an otherwise fatal disease. Our objective was to report a case of iatrogenic CJD occurring 18 years after the implant of a dural graft of human origin and to inform on the results of the treatment with quinacrine and chlorpromazine. CASE DESCRIPTION: In 1984, a 46-year-old woman was given a Lyodura graft for decompression of Chiari I malformation and syringomyelia. The patient was diagnosed with CJD in 2002. In view of the scarce options for treatment of CJD and after reviewing the current literature, the patient was treated with quinacrine and chlorpromazine. She showed no clinical improvement and died 6 months after hospital admission. The iatrogenic origin of the disease in this patient is supported by the clinical features, laboratory data, and findings from the brain necropsy. CONCLUSIONS: patients who have received a dural graft of cadaveric origin may be at risk for developing CJD after very prolonged incubation periods. Treatment with quinacrine and chlorpromazine for acquired CJD was ineffective in our patient. A clinical trial on the use of antiprion agents is warranted.- - - - - - - - - - ranking = 1keywords = transmission (Clic here for more details about this article) |
5/11. The transmission of candida albicans by cadaveric allografts.Two transplant patients suffered Candida infections after receiving homografts from a cadaveric donor whose urine culture yielded candida albicans greater than 100,000 colonies per ml. In both patients the infections became apparent after large doses of methylprednisolone were administered for acute rejection. flucytosine proved to be inadequate therapy but modified doses of amphotericin b served to eradicate the infection in each case. Donor urine cultures yielding candida albicans should be interpreted as representing a transmissible infection.- - - - - - - - - - ranking = 4keywords = transmission (Clic here for more details about this article) |
6/11. The transmission of hepatitis b by renal transplantation.A case of a renal transplant is reported with hepatitis b infection acquired directly from the cadaveric kidney of a previously unrecognized hepatitis b carrier. In retrospect, the recipient's serum became reactive for the virus 6 days postoperatively which was not recognized for ten weeks thereby placing at risk for secondary transmission almost 100 health care deliverers. Of interest, the other kidney from the same donor caused only antibody conversion in its recipient. This kidney was mechanically perfused prior to implantation while the infected recipient's transplant was cold stored.- - - - - - - - - - ranking = 5keywords = transmission (Clic here for more details about this article) |
7/11. Transmission of cancer with cadaveric donor organs.A case is presented in which each of the recipients of a pair of cadaveric kidneys developed metastatic carcinoma. One of the recipients died, and the other demonstrated involution of metastatic deposits after graft nephrectomy and withdrawal of immunosuppression. By the use of polymerase chain reaction of minisatellite regions of donor and recipient dna, the donor origin of the tumor was conclusively demonstrated. Although a relatively uncommon complication of cadaveric renal transplantation, the transmission of cancer with cadaveric organs may become more frequent as older donors are accepted for organ donation.- - - - - - - - - - ranking = 1keywords = transmission (Clic here for more details about this article) |
8/11. Accidental transmission of Creutzfeldt-Jakob disease by dural cadaveric grafts.Four patients who received dural grafts of cadaveric origin in the course of posterior fossa procedures subsequently developed Creutzfeldt-Jakob disease (CJD). The interval from dural placement to clinical onset of CJD ranged from 16 months to nine years. Initial clinical presentation consisted of cerebellar symptoms, with dementia and myoclonus developing in later stages of the disease. EEGs showed diffuse slowing that evolved to a periodic activity pattern. CT and MRI were unremarkable in the early stages but pronounced cerebral and cerebellar atrophy with widened sulci and collections of fluid over the convexities were seen in the late stages of disease. The diagnosis was histologically proved by brain biopsy in all four cases. Molecular genetic analysis showed that the four patients were homozygous for methionine at codon 129 of the PrP gene. From this experience, and from six previous descriptions of this occurrence in the literature, it is manifest that awareness of the means of iatrogenic transmission of CJD, and the adoption of preventive measures, constitute the only effective way to stop the spread of CJD among patients who have neurosurgery.- - - - - - - - - - ranking = 5keywords = transmission (Clic here for more details about this article) |
9/11. Simultaneous development of diffuse immunoblastic lymphoma in recipients of renal transplants from a single cadaver donor: transmission of Epstein-Barr virus and triggering by OKT3.Rapidly progressive diffuse immunoblastic lymphoma is an uncommon but devastating complication of organ transplantation that typically occurs early in the postoperative period. The fulminant course is characterized by progressive encephalopathy and coagulopathy, with malignant B-cell infiltration in the graft and other sites. Both de novo infection with Epstein-Barr virus (EBV) and treatment with the monoclonal antibody OKT3 have been implicated in the development of this disorder. We report two patients who received renal transplants from the same cadaver donor, with transmission of EBV from the same source, in whom treatment with OKT3 for acute rejection triggered the simultaneous development of fulminant and fatal B-cell immunoblastic lymphoma. We suggest that antilymphocyte agents be used with caution in EBV-seronegative graft recipients who receive a transplant from an EBV-seropositive donor to minimize the risk of this lethal complication.- - - - - - - - - - ranking = 5keywords = transmission (Clic here for more details about this article) |
10/11. Pediatric Creutzfeldt-Jakob disease: probable transmission by a dural graft.A 10-year-old boy underwent a posterior fossa craniectomy for removal of a grade 2 cerebellar astrocytoma. Dural closure was achieved by the placement of a dural graft. Eight years later the patient developed dementia and myoclonus. electroencephalography demonstrated generalized slow activity that evolved into a pattern of periodic triphasic waves. Computed tomography scan and magnetic resonance imaging were unremarkable. brain biopsy confirmed spongiform encephalopathy of the Creutzfeldt-Jakob type. In the light of previous reports of four similar occurrences, and of our own experience with two further cases of this disease, we believe that the cadaveric dura was the source of transmission of Creutzfeld-Jakob disease in our patient. The authors remark the importance of the awareness of this late complication of dural substitutes, both for the diagnosis of possible future cases and for taking preventive measures to stop the spread of the disease.- - - - - - - - - - ranking = 5keywords = transmission (Clic here for more details about this article) |
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