Therapeutic drug monitoring in de novo kidney transplant receiving the modified-release once-daily tacrolimus.

INTRODUCTION: Advagraf (AVF) a new formulation of tacrolimus (TRL), allows once-daily administration while showing similar efficacy and safety to the conventional Prograf (PGF), which is prescribed twice daily. Our study sought to compare short-term therapeutic drug monitoring (TDM) of AVF and PGF in de novo kidney transplants. PATIENTS AND METHODS: We retrospectively collected results of TDM performed on blood trough samples (C0) using an LC- MS/MS assay to quantify TRL exposure in the two groups. Twelve subjects received initial immunosuppression with AVF associated with mycophenolic acid, steroids, and immunoglobulins. We compared median doses and C0 levels with those obtained in 18 cases receiving an equivalent dose of PGF during the same period. RESULTS AND DISCUSSION: Although both groups showed similar mean C0, the median dose in the AVF group tended to be higher than the PGF group-respectively, 9.8 and 7.9 mg/d-which may be attributed to the once-daily regimen, which inevitably results in lower C0 levels compared to the twice-a-day regimen, while overall exposure appeared similar in terms of area under the curve (AUC). This observation occurred especially during the first weeks despite the extended release formulation. In fact, one patient who showed a low C0 (5.9 ng/mL) while receiving high doses of AVF (0.28 mg/kg), the AUC of 356 and 211 ng.h/mL performed on days 12 and 18 respectively showed exposure consistent with efficacy. CONCLUSION: In conclusion, it seemed to be necessary to use higher doses (25%) of Advagraf to reach the targeted C0 levels during the first weeks posttransplant. For patients who do not reach the targeted C0 despite high doses, TRL exposure should be assessed by AUC or peak levels (C4h).

[T3 and T4 cancer of the oral cavity, surgical treatment with oral tongue resection]. / Cancers T3 et T4 de la cavité buccale, traitement chirurgical par amputation de la langue mobile.

Amputation of the oral tongue is required to treat T3 and T4 bilateral tumors of the anterior two third of the tongue with or without extension to the floor of the mouth. This partial glossectomy was performed initially for 27 patients and as salvage therapy for 35 patients with recurrent diseases. The reconstruction required a flap in all cases, including 8 microvascular free flaps. Two months after surgery, two third of patients had a satisfactory swallowing hability. The functional results were worst for patients operated after radiotherapy. Actuarial survival rates were 37.5% and 22.1% at 3 and 5 years respectively. The survival rate of patients who had surgery as primary modality of treatment was significantly better as compared with those who had radiotherapy before surgery (p=0,018). This surgery offers a perfect control of tumors of the anterior floor and oral tongue and good rehabilitation provided by the conservation of the posterior tongue.

[Treatment of salivary gland calculi by extracorporeal lithotripsy]. / Traitement des calculs salivaires par lithotripsie extracorporelle.

This study was designed to evaluate the efficacy of extracorporeal lithotripsy (ECL) in the treatment of salivary stones. In a prospective study, 15 patients suffering from sialolithiasis were treated by applying extracorporeally generated shock waves. No patients needed general anaesthesia, sedatives, or analgesics. Treatment was effective in 80% of the 15 patients in this series (5 total efficacy, and 7 partial efficacy). Only minor complications were observed. Lithotripsy is a promising nonsurgical therapy for the treatment of sialolithiasis.

[Tuberculous angina. Apropos of a case in Senegal]. / L'angine tuberculeuse. A propos d'un cas au Sénégal.

Tuberculosis sore throat remains relatively rare, is very deceptive, especially in its pseudo-neoplasmic form, and difficult to diagnose at first examination. This should be kept in mind, because correct diagnosis avoids the consequences of diagnosing a malignant tumor.

[2 cases of unilateral nasal obstruction related to rhinolithiasis]. / Deux cas d'obstruction nasale unilatérale liée à une rhinolithiase.

Authors report two cases of 31 and 42 year old women who for many years had a unilateral nasal obstruction: first case due to a large polyp, second one due to a mucosal inflammation but both caused by a rhinolithiasis. The latter is formed over several years around a vegetable seed or a piece of material neglected since childhood. The rhinolithiasis is a calcareous concretion formed in layers visible by X-rays. This type of growth is usually enhanced by weak economic development of certain countries.

[Implantation of pancreatic islets in arteriolar epiploic flap. Preliminary note on 3 cases]. / Implantation d'ilôts pancréatiques en site artériolaire épiploïque. Note préliminaire à propos de 3 cas.

Presently, no long-term insulin withdrawal after islet graft in a diabetic patient has been reported. From October 1988 to December 1989 we have performed 3 pancreatic islet grafts in 3 type I diabetic patients. Islets were isolated from pancreatic glands collected during multiple organs harvesting. Implantation was conducted in an original site, by an arteriolar embolization of an epiploic flap pedicled from the right gastroepiploic vessels. Those grafts were combined twice with a kidney and in one occasion with a liver transplant. After 15 months, this last case is an unique metabolic success with complete insulino-independence. Endogenous insulin-secretion determined by C-peptide measurement was not detectable before surgery but was normalized and stimulable 6 months after the graft. Insulin injections were stopped one month later. Blood glucose is fully normal since 8 months without insulin. For the two other cases with kidney transplants after two months, endogenous insulin is already detectable. Compared with 3 segmental pancreatic grafts performed during the same period, islet graft in diabetic patients appears as a promising approach.