Weight-independent dosing of cyclosporine--an alternative to the "mg/kg" doctrine.

Cyclosporine is usually prescribed as "mg CsA per kg body weight", and blood levels are used for guiding CsA therapy. The present study evaluated whether it is sensible to dose in "mg/kg" if one wishes to obtain specific CsA blood levels. In a retrospective analysis, 1071 consecutive CsA whole-blood trough levels from 164 renal transplant patients, measured by monoclonal parent RIA, were correlated with the respective oral CsA doses and several demographic parameters, including gender, age, weight, height, and time after transplantation. From this, we derived a concept of "weight-independent CsA dosing" which was prospectively tested in three series of patients during the first days after renal transplantation: 58 patients received 2x 100 mg/day CsA from day 0 with the intention to reach target levels of 40-80 ng/ml, 42 patients received 2x 200 mg/day CsA from day 4 (target: 100-200 ng/ml), and 38 patients received 2x 300 mg/day from day 4 (target: 100-200 ng/ml). In the retrospective analysis, the individual, patient-specific relation of CsA level to CsA dose (in mg) was found to depend only on height (P = 0.02) and time after transplantation (P < 0.001), but not on body weight (b. wt.). If the CsA dose was expressed in "mg/kg", patients < or = 55 kg b. wt. required nearly twice the doses of patients > or = 75 kg b. wt., whereas the mean CsA requirement was the same when expressed in "mg".(ABSTRACT TRUNCATED AT 250 WORDS)

Prevention of cancellous bone loss but persistence of renal bone disease despite normal 1,25 vitamin D levels two years after kidney transplantation.

Osteopenia has been observed to occur frequently after renal transplantation. The present study was undertaken to assess whether an immunosuppressive regimen combining cyclosporine with no or the lowest possible maintenance doses of glucocorticoid may prevent osteopenia after kidney transplantation. Thirty-four patients were prospectively followed for two years. Serial blood drawings were done for determination of serum indices of calcium and bone metabolism and an iliac crest bone biopsy was performed at time of transplantation. A second bone biopsy was done in 20 patients during the second year of observation. Creatinine clearance was 56 +/- 6 ml/min one year and 46 +/- 6 ml/min two years after transplantation. Serum parathyroid hormone levels were elevated in 24 patients at time of grafting, decreased significantly thereafter, but remained above the normal range. Ten patients had low or normal serum parathyroid hormone levels at time of transplantation and showed a significant increase after grafting. Two years after transplantation, the mean cumulative dose of prednisone was 5.9 +/- 0.5 g. After the first six months, 30-40% of the patients were not on maintenance doses of steroids. None of the patients experienced fractures, and cancellous bone volume was within or above the normal range in all repeat bone biopsies. It is of note that metabolic bone abnormalities did not resolve 1-2 years after transplantation despite normalization of serum 1,25 vitamin D levels. The histologic abnormalities at the time were consistent with the bone findings in renal failure suggesting resistance of bone to normal circulating levels of 1,25 vitamin D.

[Overview: varicosis (author's transl)]. / Chirurgie der Venen Ubersicht: Varicosis.

The prevalence and sociomedical importance of peripheral venous diseases and peripheral venous disorders are discussed on the basis of a prospective epidemiologic field study (Basle Study) among 4529 apparently healthy workers and clerks of the Basle pharmaceutical industry. Prevalence: Pulmonary embolism was reported in 2% phlebitis in 10%. Varicose veins were present in 56% and signs of chronic venous insufficiency in 16%, respectively. Reticular and hyphen web varices predominated. Stem varicose veins were found in 15%. The sociomedical importance of varicose veins is evaluated according to the rates of complication and treatment. A medically significant varicosity was present in 12% of this working population. Three percent presented severe alterations that already had caused complications and 9% presented changes indicating.