Pharmacokinetics of ganciclovir in renal transplant children

Three cytomegalovirus (CMV)-seronegative children received renal transplants from CMV-seropositive donors and developed clinical symptoms of CMV infection between days 20 and 34 post transplantation. Ganciclovir (DHPG) was administered in a 1-h infusion, and the doses and dose intervals were adapted to the degree of renal insufficiency, according to the manufacturer's recommendations for adults. Individual pharmacokinetic parameters of DHPG were determined and were markedly altered. Plasma clearances were 0.4, 1.1 and 2.2 ml/min per kg and were related to individual creatinine clearances (20, 45 and 60 ml/min per 1.73 m²); the corresponding elimination half-lives were 23.7, 9.9 and 3.9 h. In two patients, the doses had to be further reduced in order to maintain plasma levels within the recommended values for peak and trough plasma concentrations. Therefore, monitoring of DHPG appears essential in adjusting dosage for optimal efficacy and minimal toxicity.     

Relative role of abdominal pelvic CT and lymphangiography in staging of testicular seminoma

Sixty patients with testicular seminoma were reviewed regarding the evaluation of the retroperitoneal lymph nodes. Thirty-four of these patients had both abdominal pelvic computerized tomography (APCT) scan and bipedal lymphangiography (LAG). In 21 patients, the results of the two studies were in agreement. However, 11 patients had positive LAG and negative APCT, while only 2 had a positive APCT and negative LAG. We recommend that patients with testicular seminoma have an APCT. If findings are negative, LAG should be done.     

Multicentric Kaposi's sarcoma of the conjunctiva in a male homosexual with the acquired immunodeficiency syndrome

A 38-year-old male homosexual with the new Acquired Immunodeficiency Syndrome (AIDS) had biopsy proven Kaposi's sarcoma of the right palpebral conjunctiva, extraocular mucocutaneous areas, and lymph nodes. Histologically, the palpebral tumor was characterized by atypical spindle cell proliferation and multiple slit-like vessels. Staining for Factor VIII-related antigen was positive in the cytoplasm of some tumor cells. Electron microscopy disclosed Weibel-Palade bodies in cells lining scattered slit-like vascular channels. The palpebral tumor mass was relatively nonadherent to its surrounding tissues and thus its simple excision was noteworthy; despite the prominent vascularity of the tumor, minimal bleeding was associated with its surgical resection. Any patient with AIDS should have all mucosal surfaces routinely examined for the presence of Kaposi's sarcoma lesions.     

Prognosis of lupus membranous nephropathy in children

The occurrence of membranous nephropathy in pediatric series of systemic lupus erythematosus has been reported only rarely, probably due to a very low frequency. One hundred fifty-four children who were seen in 100 French pediatric centers between January 2002 and April 2005 were included. Fifteen (12 girls and three boys) out of the 81 (18.5 %) children with renal involvement presented histological features of membranous nephropathy. Their ages ranged from six to 15 years old (mean=11.3) at the age of SLE diagnosis and 8/15 children were of African origin. Isolated membranous nephropathy was observed in nine patients, of whom five patients displayed a complete recovery following immunosuppressive treatment. Associated proliferative lesions were observed on the first kidney specimen in two patients and in a further renal biopsy in four other patients, leading to a less favorable course of lupus nephropathy.     

Surface disinfection of packed red blood cells with 70% ethanol

No data or recommendations are available on feasibility of surface disinfection of blood bags, but some circumstances can make such procedures inevitable. Impact of immersion of blood bags in 70% ethanol for 30min was investigated with respect to alcohol penetration and changes of hemolysis parameters in the product, and bag material changes influencing material stability and composition. After immersion ethanol concentration in blood bags was below detection limit. Hemolysis parameters did not differ between blood products that had been exposed to ethanol and a control group. Inner surface of the bag material was unchanged according to our infrared spectrometry results. Also endurance testing showed no altered results. We conclude that immersion of blood bags in 70% ethanol for surface disinfection is a safe procedure for the quality of the blood product and the bag material.     

Developmental toxicity of the angiotensin II type 1 receptor antagonists during human pregnancy: a report of 10 cases

OBJECTIVE: Angiotensin II type 1 receptor antagonists (ARA). Interacted with the renin-angiotensin system, and the present study was undertaken to examine their fetal and neonatal toxicity when taken by the mother during pregnancy. DESIGN: Prospective follow up of pregnant women exposed to an ARA during early pregnancy. SETTING: The present study was conducted in the departments of Paedriatric Pharmacology of the University hospital Robert Debre in Paris, France. POPULATION: Ten women exposed to an ARA during early pregnancy. METHODS: Prospective follow up. MAIN OUTCOME MEASURE: Fetal ultrasonography and outcome of pregnancy. RESULTS: Prenatal ultrasonography showed abnormal features in five cases (oligoamnios related to fetal tabular dysgenesis, fetal dysmorphia and renal abnormalities). Outcome of pregnancy was as follows: three induced abortions, two stillbirths (twin pregnancy), one neonate presenting with dysmorphia and renal disease and five neonates with an uneventful development. CONCLUSION: Women of reproductive age should be advised of the possible hazards of ARA and treatment should be stopped as soon as pregnany has been documented.