Dose increase needed in most cystic fibrosis lung transplantation patients when changing from twice- to once-daily tacrolimus oral administration.

AIM: The aim of this pharmacokinetic (PK) study was to evaluate tacrolimus (TAC) exposure in stable cystic fibrosis (CF) lung transplant (LT) recipients, converted from TAC twice daily to TAC once daily in an open-label, prospective, single-centre study. METHODS: Eligible patients were post-transplant CF patients (18-65 years) with stable lung function, on stable doses of TAC twice daily and who were candidates to switch to TAC once daily. Twelve consecutive patients were included in the study. Patients had their first PK analysis on day 1, still under the stable TAC twice-daily regimen, and were converted to TAC once daily from day 2 onwards. The doses were adjusted according to clinical judgement to achieve target levels, and a second 24-h PK period profile was obtained once the patient was on a stable dosage on the therapeutic range. RESULTS: The mean total (SD) daily dose of TAC twice daily at baseline upon enrolment was 0.17 (0.10) mg/kg/day. The mean (SD) daily dose of TAC once daily after adjustments was 0.22 (0.12) mg/kg/day. In order to achieve target C min levels with a similar AUC0-24, 82% of subjects who were converted to TAC once daily required an increase of dose, in a range of 0-66.7%, with a mean dose increase of 28%. CONCLUSIONS: Our study results indicate that the switch for conversion from TAC twice daily to TAC once daily in patients with CF may need dose adjustment in order to reach levels within the therapeutic target.

Linfoma no Hodgkin primario de mandíbula / Primary Non-Hodgkin lymphoma of the mandible

Introducción: Los linfomas primarios extranodales, delocalización mandibular suponen menos del 0,6% de los linfomas.Desde 1939 únicamente hay descritos 41 casos deLinfoma No-Hodgkin intramandibular, la mayoría de subtiposagresivos, ninguna de las referencias corresponde a linfomalinfocítico crónico. Pacientes y métodos: Se presentael caso de una mujer de 64 años con radiología de lesiónaparentemente quística. Se realiza resección que se remitepara estudio histopatológico donde se comprueba infiltraciónmedular por linfocitos de pequeña talla, con patrónparcheado, mientras que el análisis inmunohistoquímicoresulta positivo para CD20, CD23 y BCL-2 y negativo paraCD 10, CD5 y Ciclina D1. Resultados: Se diagnostica delinfoma No-Hodgkin mandibular, de bajo grado, (Linfocíticocrónico) mostrando ausencia de diseminación en el estudiode extensión, por lo que se cataloga de estadio I de Ann-Arbor. Discusión y conclusiones: El diagnóstico es siemprehistológico con apoyo inmunohistoquímico, ya que con frecuenciason asintomáticas o de clínica inespecífica, y conradiología no sospechosa. El pronóstico es muy favorable enlos casos diagnosticados en estadios iniciales, con supervivenciaslibres de enfermedad muy largas

Introduction: Primary extranodal mandibular bonelymphomas account for less than 0,6%. Since 1939 only 41reported cases were found in a literature review, none ofthem corresponding to small cell lymphocitic lymphoma.Patients and Methods: A case of a 64-years-old womanwith a mandibular radiologically cystic lesion is reported.Surgical resection specimen was submitted for histopathologicalstudy. A patchy bone marrow infiltration by smalllymphocytes was found. By immunohistochemistrylymphocytes were positive for CD20, CD23 and BCL-2 andnegative for CD 10, CD5 and Cycline D1. Results: Diagnosisof of low grade non disseminated (after a stagingstudy) mandibular non-Hodgkin lymphoma, belonging toAnn-Arbor´Stage I was delivered. Discussion: Diagnosis isalways histopathologic with immunohistochemical support,since these lesions are usually asymptomatic with non-specificradiology. Prognosis is really favorable with very longdisease free survival periods in those cases diagnosed atinitial stages

What is the role of bone scintigraphy in the diagnosis of infected joint prostheses?

AIM: To analyse the role played by bone scintigraphy in the diagnosis of infected joint prostheses. METHODS: The study included 77 patients, aged 32-77 years, in whom infection of a joint prosthesis (48 hip, 29 knee) was suspected. In all patients the following examinations were performed consecutively: a two-phase Tc methylene diphosphonate (Tc-MDP) bone scan, a Tc hexamethylproplyene amine oxime (Tc-HMPAO) labelled white blood cell (WBC) scan, and a Tc microcolloid bone marrow (BM) scan. The minimum interval between examinations was 48 h. The diagnoses were based on data obtained from bacteriological cultures. RESULTS: The bone scan was positive in all patients and 28 of them had an infection (sensitivity 100%, specificity 0%). The WBC scan was positive in 61 patients but only 27 had an infection. The WBC scan was negative in 16 patients, and the possibility of infection was discarded in 15 of these cases (sensitivity 96%, specificity 30%). The results of the bone marrow scan were not compatible with those of the WBC scan (suggestive of infection) in 27 patients: 26 of them had prosthesis infection. The results of both examinations were compatible in the other 34 patients and the possibility of infection was discarded in 33 of these patients (sensitivity 92.8%, specificity 98%). The addition of a BM scan to a WBC scan decreased the sensitivity from 96% to 92.8% but increased specificity from 30% to 98%. The addition of a bone scan to this dual combination did not alter the results. CONCLUSIONS: When infection of a prosthesis is suspected the diagnostic procedure should start with a WBC scan followed, if positive, by a BM scan. This procedure reduces the cost, the time required for a diagnosis, and the dose of radiation received by the patient.