ABSTRACT
A 73-year-old man presented with acute renal failure due to bilateral hydronephroses. Urography and CT scan revealed stenosis and medial deviation of the bilateral ureters surrounded by a soft tissue mass at the level of the 4-5th lumber vertebrae. Under a diagnosis of retroperitoneal fibrosis, bilateral nephrostomies were temporarily placed and prednisolone administration was initiated at a dose of 20 mg/day. Ureteral passage markedly improved within 2 weeks in association with a decrease in size of the retroperitoneal soft tissue mass. The steroid therapy was continued for 4 months with decreasing dosing schedule. The patient has been doing well without any signs of recurrence for 3 months after the cessation of the steroid therapy.
Subject(s)
Prednisolone/therapeutic use , Retroperitoneal Fibrosis/drug therapy , Aged , Drug Administration Schedule , Humans , Male , Prednisolone/administration & dosageABSTRACT
BACKGROUND: The circadian variation of clinical pharmacokinetics of tacrolimus in kidney transplant recipients receiving continuous intravenous administration has not been clarified. The aim of this study was to evaluate the circadian variation of this drug in continuous intravenous administration, with regard to the dosing scheme for conversion from intravenous to oral therapy. METHODS: The blood concentration-time curve was studied in 10 living-related kidney transplant recipients, aged 18-51 years (mean, 36.5 years), 1 day before operation for preoperative oral administration, the third postoperative day for continuous intravenous administration and the sixth postoperative day at the conversion from intravenous to oral therapy. RESULTS: Although the total body clearance of daytime was slightly higher than that of night-time, the intravenous tacrolimus infusion maintained an adequate therapeutic blood concentration for 24 h. There were significant differences between the preoperative and the postoperative state in the area under the curve, total body clearance and bioavailability for the oral administration. The mean absolute bioavailability was 17.7% in preoperative and 11.1% in postoperative state, respectively and a large interindividual variation was confirmed in this parameter, which was 7.0-27.2% for preoperative and 6.4-22.0% for postoperative area under the curve, respectively. CONCLUSION: This study proposes that intravenous administration is a safe and appropriate method to achieve the required blood concentration in patients with various tacrolimus metabolism in the early post-transplant period. As the oral tacrolimus absorption was found to be variable between preoperative and postoperative states in identical patients, the conversion dosage cannot be calculated from preoperative oral or postoperative intravenous pharmacokinetics. Frequent blood concentration monitoring is needed to ensure safe treatment.
Subject(s)
Immunosuppressive Agents/pharmacokinetics , Kidney Transplantation , Tacrolimus/pharmacokinetics , Administration, Oral , Adolescent , Adult , Female , Humans , Immunosuppressive Agents/administration & dosage , Infusions, Intravenous , Male , Middle Aged , Tacrolimus/administration & dosageABSTRACT
A 62-year-old male with slight fever, anorexia and easy fatigability was found to have a tumor in the left adrenal gland by computed tomogram of abdomen. Further study of angiogram suggesting neoplasm of the left adrenal gland, eventually he was underwent surgical extirpation. Histological study, combined with immunohistochemical staining, revealed that the tumor measuring 8 x 4 x 6 cm was an angiosarcoma. The patient died of pulmonary dysfunction 42 days after the operation. Autopsy was not done. In the literature, 7 cases of adrenal angiosarcoma have been reported; ours is the 8th case.
