Micafungin in pediatrics: when one size does not fit all

Micafungin is one of three FDA-approved echinocandins, a novel class of antifungal agents that target 1,3-beta-D-glucan in the fungal cell wall. Its spectrum of activity and favorable safety profile have made it an attractive option in the treatment of invasive Candida and Aspergillus infections. Since its approval in 2005 in the US, a variety of studies describing micafungin's use in the pediatric population have been published. As with many drugs, the pharmacokinetic profiles observed in the pediatric population differ from those seen in adult studies. A thorough understanding of the unique characteristics of this drug in the pediatric population is essential in order to optimize treatment outcomes for this diverse population of patients.     

Immunoglobulin and complement depositions in the liver of chronic hepatitis patients

BACKGROUND/AIMS: Liver biopsy is a cornerstone in the management of chronic hepatitis patients. In biopsy, liver cell damage as well as severity of inflammatory cell infiltration in the parenchyma and portal tracts are evaluated. There are some other inflammatory markers such as complements (C) and immunoglobulins (Ig), which are involved in the pathogenesis of inflammation. This study was carried out to investigate the status of Ig and C depositions in the liver of chronic hepatitis cases. METHODOLOGY: Two biopsy samples were taken from patients who were scheduled for liver biopsy for chronic hepatitis. The acetone fixed sections were incubated with fluorescin-conjugated anti human IgG, IgA, IgM, C3 and C4. Ten samples of non-hepatitis control cases were provided during elective cholecystectomy. RESULTS: Deposition of IgG, IgM, and Cs were seen in the parenchyma in HBV, HCV and non viral hepatitis cases. The parenchyma of control liver did not show any deposition of IgG, IgM, and Cs. IgA was found in the parenchyma of 3 control cases. C3 deposition in the parenchyma had significant association with enzyme rising in HCV (p=0.001) and non viral groups (p=0.004). C4 deposition in the parenchyma was also associated with enzyme rising in HCV cases (p=0.01). There was an association between ALT elevations with the presence of IgM in the parenchyma in HBV (p=0.01) and HCV (p=0.03) groups. Mantel-Haenszel chi2 test (for evaluation of the effects of stage and grade) confirmed that the depositions of C3 and C4 in HCV and C3 in nonviral hepatitis have positive association with enzyme rising. CONCLUSIONS: Presence of IgM, IgG, C3, and C4 in the liver parenchyma is abnormal and may be helpful in histological evaluation in chronic hepatitis. Parenchymal (but not portal) depositions of C3 and C4 in HCV and non-viral hepatitis cases show close association with elevation of liver enzymes.     

Intraoperative extracorporeal membrane oxygenation and the possibility of postoperative prolongation improve survival in bilateral lung transplantation

Objectives

The value of intraoperative extracorporeal membrane oxygenation (ECMO) in lung transplantation remains controversial. In our department, ECMO has been used routinely for intraoperatively unstable patients for more than 15 years. Recently, we have extended its indication to a preemptive application in almost all cases. In addition, we prolong ECMO into the early postoperative period whenever graft function does not meet certain quality criteria or in patients with primary pulmonary hypertension. The objective of this study was to review the results of this strategy.

Change in the hepatic profile of hepatitis C virus genotype 4–infected patients with compensated cirrhosis receiving ombitasvir,paritaprevir, and ritonavir plus ribavirin: A subanalysis of the AGATE‐II study

In AGATE‐II, treatment with ombitasvir coformulated with paritaprevir/ritonavir plus ribavirin (RBV) in Egyptians infected with hepatitis C virus genotype 4 resulted in high rates of sustained virologic response at post‐treatment week 12. This subanalysis examined the effects of treatment in AGATE‐II on liver biomarkers in patients with compensated cirrhosis. AGATE‐II was a phase 3, open‐label, partly randomized trial of ombitasvir/paritaprevir/ritonavir with weight‐based RBV daily once in treatment‐naive or treatment‐experienced patients. Patients without cirrhosis received treatment for 12 weeks and patients with compensated cirrhosis were randomized 1:1 to the same regimen for either 12 or 24 weeks. Sixty patients with compensated cirrhosis were randomized to treatment for 12 weeks (n = 31) or 24 weeks (n = 29). In the 12‐week arm, significant improvements were observed in biomarkers of liver injury (alanine aminotransferase: –53.7 U/L, P < 0.001; aspartate aminotransferase: –35.9 U/L, P < 0.001) and liver fibrosis (aspartate aminotransferase to platelet ratio index: –0.987, P < 0.001; fibrosis‐4 index: –1.165, P < 0.001). Similar results were reported in the 24‐week arm. Treatment with ombitasvir/paritaprevir/ritonavir plus RBV in hepatitis C virus genotype, 4‐infected Egyptians with compensated cirrhosis resulted in improvements in certain biomarkers of liver synthetic function, injury, and fibrosis, independent of treatment duration.     

Occult primary parotid gland acinic cell adenocarcinoma presenting with extensive lung metastasis

Acinic cell adenocarcinoma is a malignant salivary gland neoplasm with a relatively low rate of lymphangitic spread to regional lymph nodes. Distant metastases are rare and their occurrence typically indicates an unfavorable outcome. We encountered an unusual example of acinic cell adenocarcinoma that initially presented in the lung, whereas the primary parotid carcinoma, despite extensive clinical evaluation, only became apparent 1 year after initial diagnosis. The histologic, immunohistochemical, and ultrastructural features of the tumor in the parotid gland and lung were similar. The tumor displayed an aggressive behavior resulting in death within 2 years of the initial presentation. This presentation is unique, showing that peripheral lung tumors of salivary gland type are likely to be metastatic, and careful clinical evaluation is warranted in establishing their primary site of origin.