Pilot Randomized Trial of Tacrolimus/Everolimus vs Tacrolimus/Enteric-Coated Mycophenolate Sodium in Adult, Primary Kidney Transplant Recipients at a Single Center.

BACKGROUND: Recent studies suggest that the combination of tacrolimus (TAC) and everolimus (EVL) could become a viable option for use as standard maintenance immunosuppression in non-highly sensitized kidney transplant recipients. METHODS: We conducted a single-center, open-label, randomized pilot trial comparing two maintenance immunosuppression regimens in non-highly sensitized, adult, primary kidney transplant recipients: (TAC/EVL, Group A) vs our standard maintenance regimen of TAC plus enteric-coated mycophenolate mofetil (TAC/EC-MPS, Group B). In both treatment arms, dual induction therapy consisting of anti-thymocyte globulin (Thymoglobulin) and basiliximab was given. Early corticosteroid withdrawal (by 7-10 days posttransplantation) was also planned in both arms. There were 30 study participants, 15 per treatment arm. Results during the first 12 months posttransplantation are reported here. RESULTS: Between 1 month and 12 months posttransplantation, mean TAC trough levels ranged between 5 and 8 ng/mL in both arms. Mean trough EVL level in Group A ranged between 4 and 6 ng/mL, and mean EC-MPS dose in Group B ranged from 1440 mg at 1 month to 945 mg at 12 months. One patient in Group A vs three patients in Group B experienced a first biopsy-proven acute rejection during the first 12 months posttransplantation (P = .32). Four patients in each group experienced biopsy-proven chronic allograft injury (interstitial fibrosis/tubular atrophy) (P = .99). There was a slight trend toward more favorable renal function in Group A at months 1-3 posttransplantation (P = .06, .10, and .18 for estimated glomerular filtration rate, respectively). No graft failures or deaths were observed in either group during the first 12 months posttransplantation. Four patients in each group developed an infection during the first 12 months posttransplantation. Two patients in Group A developed new-onset diabetes after transplant during the 12-month follow-up period, vs no patients in Group B (P = .13). CONCLUSION: TAC/EVL may be a viable alternative to TAC/EC-MPS for use as standard maintenance immunosuppression in non-highly sensitized kidney transplant recipients and should be given further consideration.

Obstetrical outcome in the very young adolescent.

PURPOSE AND METHODS: To determine the obstetrical outcome in adolescent pregnancies younger than 15 years of age. A retrospective multivariant analysis from January 1, 1985 to November 2, 1990 was undertaken. Comparison of all data sets were structured to analyze groups of patients < 15 years of age (group I) or 15 years of age (group II) at the time of delivery. RESULTS: No significant difference was observed between groups for mode of delivery, incidence of low birth weight delivery, or rates of preeclampsia. Group I was less likely to obtain adequate prenatal care. The development of preeclampsia and low birth weight delivery was positively correlated with late entry into prenatal care. Rates of preeclampsia for both groups exceed normal levels for this patient population. CONCLUSIONS: Efforts to promote utilization of the health care system are of paramount importance in the very young adolescent age group.

The Birmingham bone anchored hearing aid programme: referrals, selection, rehabilitation, philosophy and adult results.

The Birmingham bone anchored hearing aid team is part of the Birmingham osseointegrated programme. In the first seven years of its existence it has received 309 referrals. Twenty-six per cent had suffered a congenital conductive hearing loss and 74 per cent had an acquired conductive hearing loss; the majority secondary to chronic suppurative otitis media. This report is of 68 out of 106 adults wearing bone anchored hearing aids (BAHAs). Ninety-eight per cent showed audiological improvement with the congenital group demonstrating marginally the best free-field thresholds and speech discrimination. Questionnaire data as to the patient experience confirms the benefits especially hearing in noise, and comfort, and the vast majority were more satisfied with the bone anchored hearing aid than their previous aid.

The Birmingham bone anchored hearing aid programme: paediatric experience and results.

Over a five-year period, 34 patients have been referred to the Birmingham bone anchored hearing aid programme, paediatric section, of who 21 are now wearing the bone anchored hearing aid (BAHA) and four are awaiting surgery for fitting of the BAHA. Of the patients assessed, found to be suitable and who proceeded to surgery for the BAHA, 44 per cent had Treacher Collins syndrome, 28 per cent had bilateral atresia or microtia, 16 per cent had Goldenhaar's syndrome, four per cent (one patient) had branchio-otorenal syndrome and eight per cent had chronic suppurative otitis media. This paper presents objective and subjective data collected from these patients. It is shown that the BAHA is a very effective hearing aid for children with congenital hearing loss.

Involvement in the legislative process through the state association.

Speech-language-hearing professionals need to develop a proactive posture regarding legislative issues. The first steps must begin at the local level. The state association is a reasonable and logical organization from which broader issues may be addressed, issues affecting the professionals as well as the patients/clients/students who require their services. The ideas that we generate at conferences and meetings to improve our educational and health care systems can be funneled into meaningful legislative action. The legislative issues of today become the governing regulations of tomorrow. Involvement in the legislative process helps strengthen our collective voices.

Benorylate in management of Still's disease.

The present recommended dose of benorylate is not satisfactory for the management of children suffering from inflammatory polyarthritis. A starting dose of 200 mg/kg/day should be used, and the salicylate level checked at seven days and the dosage adjusted to give an anti-inflammatory effect-that is, a blood salicylate level of between 25 and 30 mg/100 ml. Once a satisfactory level has been achieved, this dosage should be maintained with occasional monitoring of the salicylate level. The paracetamol level does not need to be estimated as it tends to follow the salicylate level, provided that liver function is normal; thus it is quite safe to monitor only the salicylate level. Given in an adequate dosage, benorylate seems to be an acceptable salicylate preparation for use in juveniles suffering from chronic polyarthritis.