Incidence of skin cancer after renal transplantation in The Netherlands

The incidence of squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) was analyzed separately in all 764 patients who received a renal allograft between 1966 and 1988 at the Leiden University Hospital. The mean follow-up period was 8.7 posttransplant years (range 1-21 years). During this time period 176 skin cancers were diagnosed in 47 patients. The overall risk to develop a first tumor increased from 10% after 10 years to 40% after 20 years of graft survival. The overall incidence of SCC was 250 times higher and that of BCC 10 times higher when compared with the general Dutch population. Moreover the localization of SCCs and BCCs differed considerably. Solar radiation is thought to be an important risk factor for the development of skin cancer. However, the occurrence of skin cancer in long-term graft survivors forms also a major problem in a country with a higher geographical latitude and a moderate amount of sun-exposure, such as the Netherlands.     

Transfer of intestinal microbiota from lean donors increases insulin sensitivity in individuals with metabolic syndrome

Alterations in intestinal microbiota are associated with obesity and insulin resistance. We studied the effects of infusing intestinal microbiota from lean donors to male recipients with metabolic syndrome on the recipients' microbiota composition and glucose metabolism. Subjects were assigned randomly to groups that were given small intestinal infusions of allogenic or autologous microbiota. Six weeks after infusion of microbiota from lean donors, insulin sensitivity of recipients increased (median rate of glucose disappearance changed from 26.2 to 45.3 μmol/kg/min; P < .05) along with levels of butyrate-producing intestinal microbiota. Intestinal microbiota might be developed as therapeutic agents to increase insulin sensitivity in humans; www.trialregister.nl; registered at the Dutch Trial Register (NTR1776).     

Psychosocial response to disaster: the attacks on the Stark and the Cole

The terrorist attack on the USS Cole on 12 October 2000 was remarkably similar to the 1987 attack on the USS Stark. This article discusses the psychosocial consequences of the attacks on the families and crews of the ships and the community response of the Navy to the attacks, particularly that of the Navy Family Service Centers. The impact of the attacks is compared to the impact of natural and man-made disasters on communities while the impact on the crew is examined in light of combat psychiatry and post-traumatic stress disorder (PTSD). Events such as these are very likely to produce PTSD despite early intervention efforts. Following the attack on the Stark greater attention was given to the grief of family members than to the trauma of the crew, while the crew of the Cole has received longer-term psychiatric assistance than in previous similar episodes.     

Chronic hepatitis ascribed to the use of sotalol]

In a 68-year-old woman with severe chronic hepatitis an extensive investigation revealed no other cause than the use of sotalol for 10 months due to atrial fibrillation. Once the use of the medication had been discontinued the patient's symptoms quickly disappeared and the liver function disorders normalised within 5 months. Sotalol is a beta-adrenergic receptor blocking and anti-arrhythmic agent. It is widely used in patients with supraventricular and ventricular arrhythmias. An adverse effect in terms of liver damage is not known. The pathogenesis of the observed hepatitis remained an enigma because sotalol is a hydrophilic substance which is not metabolized by the liver and is cleared by the kidneys unchanged.     

A Prospective Randomised Comparative Study on the Influence of Cyclosporin and Azathioprine on Renal Allograft Survival and Function

To study the effectiveness and nephrotoxic side-effects of cyclosporinA (CsA) in renal transplant recipients, a prospective randomisedtrial was designed to compare CsA with azathioprine (Aza). Eachtreatment group consisted of 40 patients; in the CsA group,18 were randomly selected for conversion to Aza after 3 months.The 1-year graft survival for CsA-treated patients was 87% comparedwith 66% for the Aza group (P=0.033). Anti-rejection therapywas administrated to 78% of the patients in the Aza group and47% of those in the CsA group (P<0.01). There was no differencein the incidence of primary non-functioning kidneys, cytomegalovirusinfections, hypertension, or degree of proteinuria between thetwo treatment groups. At 3 months the mean creatinine clearance was 42±2 ml/min(mean±SEM) for the CsA group compared with 56±4ml/min for the Aza group (P<0.01), whereas the mean creatinineclearances at 6 months for both the converted and the non-convertedCsA-treated patients did not differ from that found in the Aza-treatedgroup. At 1 year, the mean creatinine clearance for CsA-treatedpatients who were converted to Aza was higher than that foundfor Aza treated patients (62±7 vs 50±6 ml/min;P<0.05). Furthermore, the increment in creatinine clearanceobserved after conversion from CsA to Aza at 3 months showeda linear relationship (r=0.9061) with the CsA trough levelsbefore discontinuation of the drug. This indicates that CsA treatment induces a dose-dependent,nephrotoxic side-effect which is probably reversible.     

Intermediate and high-dose ARA-C and m-AMSA (or daunorubicin) as remission and consolidation treatment for patients with relapsed acute leukaemia and lymphoblastic non-Hodgkin lymphoma

27 patients (aged 15-55 years) with relapsed acute myelogenous (AML) and lymphoblastic leukaemia (ALL), and with lymphoblastic non Hodgkin's lymphoma (NHL) have been treated with intermediate dose cytosine arabinoside (AraC, 1 g/m2 q 12 h X 12) and 3 d of m-AMSA (20 patients), 90-115 mg/m2 daily, or daunorubicin (7 patients). 18 of them attained a complete remission (AML 10/14, ALL 3/5, NHL 5/8). 7 patients received consolidation treatment with 1-2 courses comprising 4 d of AraC (3 g/m2 q 12 h X 8) and m-AMSA (90-115 mg/m2) on d 5 of each course. 2 patients underwent allogeneic bone marrow transplantation and 9 received no further treatment after remission induction. In addition to vomiting, fever and conjunctivitis, toxicity in 6 patients included a combination of severe diarrhoea, fever and signs of paralytic ileus. 3 of them died during the pancytopenic phase. The pancytopenic period ranged from 16-25 d (median 21 d) after the remission induction and 14-21 d (median 19 d) after the consolidation course. Median remission duration was 5 months for those patients who received no treatment after remission induction and greater than 9 months (4+ - 16+ months) for the patients who received consolidation courses. Increased dosages of AraC are active in relapsed leukaemia and lymphoma, although optimal dose and schedule are still undetermined.     

Controlled cyclosporine conversion at three months after renal transplantation. Long-term results

The long-term results of conversion of cyclosporine to azathioprine and those of continuous CsA therapy were evaluated in a prospective study of 66 renal transplant patients who had been randomly assigned to each treatment group at 3 months following transplantation. The start point of the study was thus at 3 months posttransplant; no differences in the three-year patient and graft survival were found; these consisted of 97% and 94% in the converted group and 100% and 94% in the nonconverted group, respectively. The incidence of one or more antirejection treatments did not differ between the two groups at 3-12 months (16% vs. 17%) or after 12 months (12% vs. 9%). The incidence of hypertension at different intervals ranged from 79% to 100% in the group on continuous CsA therapy versus 50 to 58% in the converted patients. The degree of proteinuria in the 2 groups was not different at at 12 months. At 24 and 36 months the proteinuria (g/24 hr) was higher in the converted group (0.51 +/- 0.18 and 0.53 +/- 0.13; mean +/- SEM) versus the CsA group (0.15 +/- 0.04 and 0.21 +/- 0.09). At 3 years, the mean creatinine clearance for the patients converted to Aza was higher than that found for the continuously CsA-treated patients (67 +/- 8 and 59 +/- 6 ml/min; mean +/- SEM). This study shows that early CsA conversion to Aza gives a slightly better 3-year graft function, although not significantly different, compared with continuous CsA therapy without differences in patient or graft survival.