Risks associated with conversion of stable patients after liver transplantation to the microemulsion formulation of cyclosporine.

BACKGROUND: Neoral is a microemulsion formulation of cyclosporine that has a better pharmacokinetic profile than the standard formulation (Sandimmune). To prove the safety of converting stable liver transplant patients from Sandimmune to Neoral, we conducted a prospective trial involving 54 patients. METHOD: The average time from transplantation to conversion was 48.5+/-21.6 months. Thirty of 54 patients (55%) required a dose reduction during the study for various reasons. Five of 30 patients had the first dose reduction because of increased levels of cyclosporine. Seven patients required more than one dose reduction. RESULTS: Sixteen patients suffered serious adverse events. Six patients had a biopsy-proven rejection. Four of 6 patients had trough cyclosporine levels within 20% of baseline value immediately before developing rejection. CONCLUSION: Converting patients from the standard formulation to the microemulsion formulation of cyclosporine seems to expose stable patients to unnecessary risks.

The anatomy of the adult uropodid Fuscouropoda agitans (Arachnida; Acari), with comparative observations on other Acari.

A thin, compressible, lateral suture and ventral plate overlap permit limited movement of the thick and rigid dorsal and ventral plates of Fuscouropoda agitans. Seven pairs of large dermal glands debouch onto the surface. Trochanteral rotation permits defensive leg adpresion and an insectan type of ambulation. The complex hypopharynx-pedipalpal-coxae has a buccal and cheliceral cavity separated by an atriculated epipharynx. The pharynx is Y-shaped in cross section. Extensive paired salivary glands lie above the very long and dexterous 3-segmented chelicerae, and a large pair of coxal glands debouch on coxae 1. From four blunt-ended tracheae, bundles of unbranching tracheoles extend in specific tracts to all organs. The ventriculus is small with three pairs of large caeca; a tightly packed single layer of digestive cells individually enlarged to absorb-phagocytize and digest the food. A typical mesostigmatid excretory tube is present. A typical acarine synganglion is present; mixed nerves have a basal swelling. A postulated neurosecretory organ arises from the pedipalpal nerve. The oocytes enlarge within funicular stalks from the walls of the small median ovary. A large spermatophore is stored in the seminal vesicle; fertilization occurs during oviposition. A tension hinge partially opens both male and female genital plates; closure effected by muscles acting on very long genital plate apodemes. Within sequentially produced spermatogonial cysts of the testes, meiosis is completely synchronous. A large, multilobed male accessory gland produces a large volume of seminal fluid; a mixture of at least four secretions. The origins and msertions of the body wall, genital organ, digestive tract, mouthpart and leg muscles are listed and illustrated. A comparison of anactinotrichid and actinotrichid mites indicates fundamental and consistent morphological differences in aspects of the cuticle, leg articulations, digestive system, excretory system, reproductive system and coxal glands.