Investigation of potential interaction of ciprofloxacin with cyclosporine in bone marrow transplant recipients.

The effect of the 4-quinolone antimicrobial agent ciprofloxacin on the concentration in plasma and the pharmacokinetics of the immunosuppressive agent cyclosporine was studied in 10 bone marrow transplant recipients. There were no statistically or clinically significant changes in cyclosporine trough concentrations or areas under the concentration-time curve following oral doses of 500 mg of ciprofloxacin every 12 h for 4 days. The data suggest a lack of relevant pharmacokinetic interaction of ciprofloxacin with cyclosporine. There was no indication of an enhanced nephrotoxicity for this drug combination.

Absence of significant interaction of fluconazole with cyclosporin.

The effect of a new azole antifungal drug, fluconazole, on cyclosporin concentration and pharmacokinetics was studied in ten bone marrow transplant recipients. There were no significant statistical or clinical differences in mean cyclosporin trough concentrations, peak concentrations and AUCs after fluconazole given either as a single 100 mg oral dose or as 100 mg daily for 14 days. Fluconazole was well tolerated without drug related side effects. Slight to moderate increases of liver laboratory parameters were observed in four patients during the multiple dose sequence, but these changes might be attributable, in part, to the underlying diseases or concomitant therapies. The data suggest a lack of clinically relevant pharmacokinetic interaction of fluconazole with cyclosporin. It is concluded that fluconazole may be administered to cyclosporin treated patients without enhanced risk of toxicity.

Response-oriented therapy with CHOP and VIM-Bleo in high-grade malignant non-Hodgkin's lymphomas.

Twenty four patients with high grade malignant NHL (stage II 8, stage III 4, stage IV 12 patients respectively) were treated with a response-oriented regimen: Treatment was initiated according to the CHOP-protocol. Patients achieving at least a partial remission after 2 and a complete remission (CR) after 4 cycles were continued on CHOP to a total of 9 cycles. Patients not meeting these criteria were switched to a combination of Etoposide, Ifosfamide, Methotrexate, and Bleomycin (VIM-Bleo). With CHOP treatment, 16 patients (67%) achieved a CR. Of the remaining 8, 7 were treated with VIM-Bleo; 5 of these entered CR for a overall CR rate of 21/24 (88%). With a median follow up of 28 months 7 patients relapsed: 6 relapses occurred in patients with a rapid initial response and treated only with CHOP. We conclude, that there is a significant risk of relapse even in patients readily responding to CHOP and that consolidation therapy with a non cross-resistant regimen may improve results in these patients.

A case of accidental cyclosporin overdose with pharmacokinetic analysis.

In a case of oral overdose of cyclosporin we measured plasma concentrations by radioimmunoassay and high pressure liquid chromatography. We observed unchanged pharmacokinetic parameters after the overdose indicating normal renal and hepatic function. Laboratory findings showed no renal or hepatic damage. As toxic symptoms, only emesis and a short, mild drowsiness were noted.

[Pulmonary radioreaction demonstrated by x-ray pictures (author's transl)]. / Die pulmonale Strahlenreaktion im Röntgenbild. Intensität und Häufigkeit röntgenmorphologischer Veränderungen der Lunge und des Mediastinums nach Mantelfeldbestrahlung mit 4-MeV-Photonen und Satellitentechnik.

X-ray radiographs of the thorax of 119 patients suffering from Morbus Hodgkin (period of therapy VI/1974-III/1979) which have been taken during radiotherapy and at routine follow up examinations have been analysed with regard to temporal progress and extent of the pulmonary radioreaction after standardised mantle-field irradiation with a 4-MeV linear accelerator, extended-field satellite technique and tumor doses of 40-46 Gy. After a characteristic latency period without radio-morphological reaction the patients on average showed 12 weeks after beginning of irradiation signs of a beginning pneumonitis (phase I), after 15 weeks a florid pneumonitis (phase IIa), and after 20 weeks a florid pneumonitis with beginning shrinkage (phase IIb). After 5-9 months (average level 34 weeks) the pulmonary radioreaction was complete after having reached a steady paramediastinal lung fibrosis (phase IV). Classifying the radioreaction into 3 degrees of gravity a light pneumonitis was found in 44%, a medium one in 29%, and a severe pneumonitis in 16% of the cases. For clinical use it is important to know that after beginning shrinkage new expansion of mediastinum and/or of peripheral parenchymal shadows cannot be radioreactions. Primarily these new changes have to be interpreted as recurrence.

[Dental local anesthesia in patients with diabetes mellitus]. / Untersuchungen zur zahnärztlichen Lokalanästhesie bei Patienten mit Diabetes mellitus.

In 51 tooth extractions in medicinally controlled diabetics, adrenaline and noradrenaline (used as vasoconstricting additives to the local anaesthetic) did not differ in their effects on the blood-sugar level. A clinically important or lasting disturbance of the carbohydrate metabolism was observed in no case. The general preference given to noradrenaline as a vasoconstrictor in diabetics is not supported by the present study.