Postreperfusion syndrome during living-related donor renal transplantation: a case report.

UNLABELLED: Herein we report a case of postreperfusion syndrome (PRS) occurring during renal transplant. PRS, which is defined as a drop in mean arterial blood pressure by at least 30% for a minimum of 1 minute within 5 minutes of reperfusion and classically includes braydycardia and high pulmonary filling pressures, was first described in liver transplantation. Surprisingly, no case of PRS has been previously reported during renal transplantation. CASE REPORT: A 66-year-old woman underwent a living-related renal transplant. Upon completing the vascular anastomosis, arterial and venous clamps were removed to restore kidney perfusion. Subsequently, the patient developed persistent sinus bradycardia at 30 bpm with simultaneous hypotension that lasted for approximately 2 minutes. Although saline boluses, ephedrine, atropine, and 100 microg of epinephrine were administered, the patient's hemodynamics were not restored until an additional 300 microg of epinephrine were administered. CONCLUSION: This case confirms the hypothesis of previous authors who predicted that PRS likely occurs in non-liver transplantation.

Rhinitis in pregnancy.

About 30% of women suffer from nasal symptoms during pregnancy. The hormonal changes occurring during pregnancy favour per se mucosal oedema and relaxation of smooth muscles, thus contributing to nasal congestion. The most common forms of rhinitis are allergic, drug-induced, infectious and vasomotor rhinitis. In addition to the detrimental effects that rhinitis can have on quality of life, it is important to correctly treat rhinitis itself since it can influence concomitant asthma, as underlined in ARIA document. In pregnancy, the safety profile of drugs is the primary item to be considered. The American FDA pointed out that foetal damage could not be totally excluded with the majority of antirhinitis drugs. It is recommended to use "older drugs" because more data about their safety are available. Cromones are the safest drugs but, although they need multiple daily administrations. Antihistamines should be considered as second choice drugs, and their use is not recommended during the first three months of pregnancy. Topical steroids are useful in moderate-severe rhinitis, being beclometasone the most documented molecule. Topical vasoconstrictors should not be used continuously because they can induce pharmacological rhinitis. It is not recommended to start specific immunotherapy in pregnancy but it can be continued in patients who benefit from its use. Infective rhinitis should be treated with beta-lactams, cephalosporins or macrolides. Finally it is important to evaluate the cost/usefulness ratio before any drug prescription.

Flavone acetic acid distribution in human malignant tumors.

The pharmacokinetics of flavone acetic acid (FAA) after a dose of 4.8 mg/m2 given i.v. over 1 h was investigated in 13 patients with different solid tumors. The mean volume of distribution and clearance were 52 +/- 4 l/m2 and 2.6 +/- 0.2 l/h x m2, respectively. A tumor or metastasis biopsy was obtained from six patients 2 h after the end of infusion. Tumor FAA levels ranged from 39.6 to 148.8 micrograms/g and were similar to those obtained after a therapeutic i.v. dose of 200 mg/kg FAA in animals bearing Pan/03 tumor, which is very sensitive to the drug. Although FAA tumor concentration could be detected only during one interval and we therefore cannot draw a definitive conclusion, differences in the agent's antitumor activity in mice and patients (i.e. very active in the former and inactive in the latter) are apparently not due to discrepancies in drug distribution and pharmacokinetics.