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Eczematous external otitis is a common chronic condition that can have a significant impact on the life of sufferers, causing constant discomfort and pruritus, and leading to sleep deprivation. Treatment is based on the use of topical steroids, moisturisers and occasionally antibiotics. Results, however, can be disappointing, especially over the long term.
Methods
This study compared the long-term response to pimecrolimus, administered to a group of 11 patients, against clobetasone butyrate, administered to an equivalent number of patients. Response to the treatment was assessed and statistically analysed at 3 and 12 months.
Conclusion
Whereas the degree of improvement following the use of pimecrolimus and clobetasone butyrate was similar for the two groups at month 3, a highly statistically significant difference was documented at month 12, with a much greater and sustained improvement in the pimecrolimus group.
To assess the recovery of various muscle fibre types in the posterior cricoarytenoid muscle after laryngeal reinnervation in the rat, and to determine the influence of tacrolimus on this process.
Methods:
Four groups of rats underwent resection and anastomosis of the left vagus nerve, and were administered either tacrolimus at a low dose or an immunosuppressive dose, or cyclosporin A at a low dose or an immunosuppressive dose. A fifth group received surgery alone, and a sixth group received neither surgery nor drug treatment (healthy group). Muscles were removed for immunohistochemical analysis 45 days after surgery.
Results:
There was no difference in the proportion of types 1, 2a and 2b muscle fibres, comparing the immunosuppressive tacrolimus group and the healthy group, whereas there were fewer type 1 fibres in the group receiving surgery alone, compared with the healthy group (7 vs 12.1 per cent, respectively; p = 0.0303).
Conclusion:
Tacrolimus enhanced the recovery of normal laryngeal muscle fibres after reinnervation in the rat, indicating a possible role in laryngeal transplantation.
In the immediate postoperative period, close attention must be paid to hemodynamic stability by focusing on preventing right ventricular failure and maintaining chronotropic competence. Preoperative support of the recipient circulation by mechanical assist devices appears to significantly increase the risk of post-transplantation primary graft failure. Primary cardiac allograft failure accounts for 40 percentage of mortality within 30 days of heart transplantation (HT). Following HT, the use of intraoperative and peri-operative corticosteroids remains the mainstay of early therapy. Monitoring of therapeutic drug levels is important but there is some controversy in how best to monitor the target levels of calcineurin inhibitors (CNIs). Early after transplantation, particularly in the first 3 months when the risk of rejection is highest, invasive biopsies are recommended at decreasing intervals. Close vigilance for re-emergence of circulating antibodies is needed, and newer approaches using complement inhibitors or intensive B-cell modulating drugs such as bortezomib are being studied.
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