Experience with Neoral versus Sandimmune in primary liver transplant recipients

We compared results using Neoral versus Sandimmune, each in combination with steroid and azathioprine immunosuppression, in primary liver transplantation recipients. There were 15 patients in each group with similar demographic distributions. Intravenous cyclosporine was stopped at 4.3 ± 1.9 days in the Neoral group vs 7.8 ± 4.9 days in the Sandimmune group (P < 0.025). Cyclosporine levels in the first 10 days were higher (mean 306 ng/ml vs 231 ng/ml) in the Neoral group than the Sandimmune group (P < 0.05). The Neoral dose was less than the Sandimmune dose (mean 5.5 ng/kg per day vs 7.9 ng/kg per day) to achieve these levels in that time period (P < 0.05). Two patients (13 %) experienced three episodes of biopsy-proven rejection in the Neoral group compared to nine patients (60 %) with 12 episodes of rejection in the Sandimmune group (P < 0.025). Incidences of neurological and renal complications were similar between the groups. Infections requiring treatment were also similar. Liver function, renal function, and marrow function, evaluated at days 7, 14, 21, 28, and 2, 4, 6, and 12 months post-transplant, were not different between the groups. In summary, shorter use of intravenous cyclosporine and quicker stabilization of trough cyclosporine levels was achieved with Neoral than with Sandimmune. In the early posttransplant period, higher levels with lower doses were achieved with Neoral than with Sandimmune. In our experience, the incidence of rejection was lower with Neoral than with Sandimmune. There were similar lengths of hospitalization, mortality, adverse events, retransplantation, and similar liver, renal, and marrow function up to 1 year posttransplantation. Because of this experience, we continued to use Neoral in a total of 59 primary liver transplant recipients. We have not used intravenous cyclosporine in the last 44 patients. Follow-up was a mean of 11.4 months, ranging from 1 to 27 months. The incidence of rejection was 24 % in these 59 patients compared to our historical experience of 70 % using Sandimmune.     

Towards high resolution maps of the mouse and human genomes--a facility for ordering markers to 0.1 cM resolution

982 progeny produced by a mouse Interspecific backcross betweenC57BL/6 and Mus spretus have been scored for at least 3 markerson each chromosome, completing an anchor map of 78 loci acrossthe mouse genome. The anchor mapping identifies all the availablerecomblnants in each interanchor Interval allowing access topanels of mice that can be used for the high resolution mappingof any chromosome region. The large number of progeny recoveredand scored from the Interspecific backcross allows us to resolvegenetically markers that lie on average 200 kb apart on mousechromosomes and within the cloning capacity of currently availableYAC libraries. EUCIB provides the first genetic mapping resourcespecifically designed for the high resolution mapping of allregions of the mouse genome and will underpin the global physicalmapping of the mouse genome. In addition, with the use of conservedsequences the facility is applicable to the high resolutioncomparative mapping of the mouse and human genomes. A new databasehas been implemented to support the computation of high resolutionand ordered genetic maps.     

A week in the life of a travel clinic.

International travel has increased enormously in recent years. With the greater movement of people have come increased encounters with a wide variety of diseases: malaria, dengue, cholera, typhoid fever, Ebola virus, and many more. The need for greater scope, consistency, and knowledgeability in pretravel health care to meet these challenges has been met by the emergence of the discipline of travel medicine. Travelers are well advised to become informed of the risks they face and to take steps to minimize those risks. After reviewing a traveler's medical history and a detailed itinerary, a travel medicine practitioner can offer expert advice on behavioral modifications, immunizations, and chemoprophylaxis regimens which will increase the traveler's margin of safety. The issues most frequently addressed in a travel clinic include treatment of traveler's diarrhea, malaria chemoprophylaxis, and immunizations, for hepatitis A, typhoid fever, tetanus/diphtheria, influenza, pneumococcus, hepatitis B, polio, meningococcus, measles, mumps, rubella, varicella, and rabies. Pretravel consultation must consider the age and underlying health problems of the traveler, the nature of the trip (wilderness, jungle, rural, urban, resort, or cruise), the duration of travel, and the latest available information on the site in terms of disease outbreaks, terrorism, and natural calamities.     

Pterin metabolism in depression: an extension of the amine hypothesis and possible marker of response to ECT.

Urinary excretion of neopterins and biopterins was measured in 23 patients with severe depression before and after receiving electroconvulsive therapy (ECT) and 26 healthy control subjects. Patients with psychotic depression and those responding to ECT had neopterin:biopterin (N:B) ratio significantly higher than controls before commencing ECT and positive therapeutic response was associated with reduction of N:B ratio towards control values. As a raised N:B ratio implies failure to convert neopterin to biopterin it is possible that reduced availability of tetrahydrobiopterin, the essential cofactor for the formation of noradrenaline, serotonin and dopamine, may exert rate limiting control over the synthesis of monoamines implicated in the pathogenesis of depressive disorders. The N:B ratio may be a marker for certain depressive subtypes and response to ECT.     

AHNS Series – Do you know your guidelines? Principles of treatment for glottic cancer: A review of the National Comprehensive Cancer Network guidelines

This article is a continuation of the “Do You Know Your Guidelines” series, an initiative of the American Head and Neck Society's Education Committee to increase awareness of current best practices pertaining to head and neck cancer. The National Comprehensive Cancer Network (NCCN) guidelines for primary and adjuvant treatment of cancer of the glottic larynx are reviewed here in a systematic fashion according to stage.     

Gender differences in the dialysis treatment of Indigenous and non‐Indigenous Australians

Objective: Access to dialysis treatment and the types of treatments employed in Australia differs by Indigenous status. We examined whether dialysis treatment utilisation in Indigenous and non‐Indigenous Australians also differs by gender. Methods: Using registry data we evaluated 21,832 incident patients (aged ≥18 years) commencing dialysis, 2001–2013. Incidence rates were calculated and multivariate regression modelling used to examine differences in dialysis treatment (modality, location and vascular access creation) by race and gender. Results: Dialysis incidence was consistently higher in Indigenous women compared to all other groups. Compared to Indigenous women, both non‐Indigenous women and men were more likely to receive peritoneal dialysis as their initial treatment (non‐Indigenous women RR=1.91, 95%CI 1.55–2.35; non‐Indigenous men RR=1.73, 1.40–2.14) and were more likely to commence initial treatment at home (non‐Indigenous women RR=2.07, 1.66–2.59; non‐Indigenous men RR=1.95, 1.56–2.45). All groups were significantly more likely than Indigenous women to receive their final treatment at home. Conclusions: Contemporary dialysis treatment in Australia continues to benefit the dominant non‐Indigenous population over the Indigenous population, with non‐Indigenous men being particularly advantaged. Implications for Public Health: Treatment guidelines that incorporate a recognition of gender‐based preferences and dialysis treatment options specific to Indigenous Australians may assist in addressing this disparity.