[Switching to Neoral in patients with a stable kidney transplant. Retrospective study]. / Conversione a Neoral in pazienti con trapianto renale stable. Studio retrospettivo.

BACKGROUND: The aim of this retrospective study of patients with stable kidney transplantation was to evaluate "in the field" whether conversion from Sandimmune to Neoral led to a reduced variability of cyclosporinemia. METHODS: 153 patients were included in the study, from 16 centres in Piedmont, and were observed for a period of 13 months each. Data from the statutory controls specified in Piedmont for the follow-up of kidney transplantation patients were used in the evaluation. RESULTS: The mean coefficient of variation for cyclosporinemia (CV%) after conversion was slightly lower than pre-conversion CV% (22% vs 24%; p = 0.054). If the patients were divided into subgroups however, it was observed that only subjects who had presented a high CV% in Sandimmune (30%), equivalent to 23% of the population, showed greater stability in Neoral, whereas those who already presented satisfactory stability (CV% 20%), 45% of the population, underwent a deterioration of CV% in 42% of cases. The remaining 32% of patients revealed an intermediate level. CONCLUSIONS: In conclusion, this study showed that conversion to neoral is certainly indicated in those patients with a high variability of cyclosporinemia levels in sandimmun. It is not regarded as beneficial in patients with low levels of variability, also owing to the added cost. In patients with intermediate levels, ongoing studies on survival following transplantation using these two formulations will indicate the advantages or otherwise of conversion.

[Hepatitis B vaccine in dialyzed patients: persistence of antibody titres after a 48-month follow-up]. / Vaccinazione antiepatite B nei dializzati: persistenza del titolo anticorporale dopo follow-up di 48 mesi.

The persistence of a protective level of HBV antibodies 48 months after vaccination has been evaluated in 52 dialysis patients (32 vaccinated with Pasteur vaccine--group A--and 20 with recombinant vaccine--group B). A protective titer was present after 48 months in 32 group A patients (100%) and in 18 group patients (90%). After the standard vaccination program (5 micrograms at 0, 1, 2, 6, 18 months for group A and 40 micrograms at 0, 1, 2, 6, 12 months for group B) 20 group A and 6 group B patients maintained during the whole observation period of 48 months a protective titer. In 24 patients, 12 for each group, classified as non responders after the standard vaccination programme or which presented in the control during the observation time a titer lower than 50 mIU/ml, additional doses were necessary. Patients not treated with additional doses showed in both groups, after 4 and 7 months, significantly higher antibody titers in comparison with patients for which additional doses had been necessary. These patients were significantly younger in Group A. The monitoring of the antibody titers and the administration of additional doses has allowed to maintain after 48 months a protective HBV antibody level in 96.15% of the patients (50/52).

[Evaluation of the reproductive endocrine system in a population of hemodialyzed adult males]. / Valutazione dell'assetto endocrino riproduttivo in una popolazione di maschi adulti emodializzati.

There is a high incidence of sexual disorders of multifactorial origin in hemodialysed patients. The endocrine reproduction system was evaluated in 19 male adult hemodialysed patients. Slightly enhanced levels of prolactin and gonadotropins were found together with normal levels of total and free testosterone. Androgen biosynthesis intermediates were substantially normal. Hypophyseal stimulation tests using TRH and GnRH revealed a prolactin and gonadotropins response which was reduced, slow and protracted compared to normal. Hypophyseal stimulation did not cause any variation in testosterone levels. Prolactin and gonadotropins were not pulsatile. Data obtained appear to indicate that the hormonal component in sexual disorders in uremic patients is related to dynamic alterations of the system rather than basic hormonal changes.

Behaviour of indicators of exposure and effect after cessation of occupational exposure to lead.

The behaviour of blood lead (PbB) and of some indicators of effect (erythrocyte protoporphyrin IX (EP), delta-aminolaevulinic acid dehydratase activity of erythrocytes (ALAD), and urinary delta-aminolaevulinic acid (ALAU)) were studied in subjects who had ceased working with inorganic lead for at least one year. Relations between these indices and chelatable lead (PbU-EDTA (lead in urine after injection of CaNa2 EDTA 1 g intravenously)), a test that is used to evaluate the lead deposits in the body, were also analysed. As a comparison, a group of subjects currently exposed was studied. In the workers with past exposure the PbB values were significantly lower, at the same PbU-EDTA levels, than those found in subjects at work. The relation between EP and PbU-EDTA shows that, corresponding levels of chelatable lead, the values of the erythrocyte metabolite are identical in the two groups. Considering the EP-PbB relation, however, at the same PbB levels the protoporphyrin values appear distinctly more altered in the subjects with past exposure. Similar results were obtained from a study of the relations between ALAD and PbU-EDTA and between ALAD and PbB. The relation between ALAU and PbU-EDTA, however, shows that, at the same PbU-EDTA levels the urinary metabolic in past-exposed subjects is distinctly lower than in subjects at work, while the relation between ALAU and PbB shows that, for similar blood lead values, the ALAU levels are identical. On the basis of the results obtained it is concluded that in subjects with past exposure, EP and ALAD can be used in establishing the persistence and extent of an "active deposit" of lead in the organism, while PbB is of very limited use.