The LIS2T study was an open-label, multicenter study in which recipients of a primary liver transplant were randomized to cyclosporine microemulsion (CsA-ME) (Neoral) (n ϭ 250) (monitoring of blood concentration at 2 hours postdose) C 2 or tacrolimus (n ϭ 245) (monitoring of trough drug blood level [predose]) C 0 to compare efficacy and safety at 3 and 6 months and to evaluate patient status at 12 months. All patients received steroids with or without azathioprine. At 12 months, 85% of CsA-ME patients and 86% of tacrolimus patients survived with a functioning graft (P not significant). Efficacy was similar in deceased-and living-donor recipients. Significantly fewer hepatitis C-positive patients died or lost their graft by 12 months with CsA-ME (5/88, 6%) than with tacrolimus (14/85, 16%) (P Ͻ 0.03). Recurrence of hepatitis C virus in liver grafts was similar in each group. Based on biopsies driven by clinical events, the mean time to histological diagnosis of hepatitis C virus recurrence was significantly longer with CsA-ME (100 Ϯ 50 days) than with tacrolimus (70 Ϯ 40 days) (P Ͻ 0.05). Median serum creatinine at 12 months was 106 mol/L with CsA-ME and with tacrolimus. More patients who were nondiabetic at baseline received antihyperglycemic therapy in the tacrolimus group at 12 months (13% vs. 5%, P Ͻ 0.01). Of patients who were diabetic at baseline, more tacrolimus-treated individuals required anti-diabetic treatment at 12 months (70% vs. 49%, P ϭ 0.02). Treatment for de novo or preexisting hypertension or hyperlipidemia was similar in both groups. In conclusion, the efficacy of CsA-ME monitored by blood concentration at 2 hours postdose and tacrolimus in liver transplant patients is equivalent to 12 months, and renal function is similar. More patients required antidiabetic therapy with tacrolimus regardless of diabetic status at baseline. Abbreviations: CsA-ME, cyclosporine microemulsion; CsA, cyclosporine; C 2, blood concentration at 2 hours postdose; HCV, hepatitis C virus; C 0, trough drug blood level (predose).

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Solid organ transplant/HSCT recipients are at risk of orofacial diseases. Adequate management of these patients alleviates local symptoms responsible for impaired eating, helps prevent systemic and lethal complications, and helps where dental healthcare has been neglected.

SUPPLEMENT nnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn n As reported in the literature, the mortality rate for patients with Acute Hepatic Failure (AHF) approaches 80 % in cases in which liver transplantation is not possible.Post transplant mortality depends on the seriousness of the neurological condition at the time of the operation (20 % in I-II degree coma patients and 44 % in III degree coma patients). This is the rationale for extracorporeal depuration treatment, as a bridge to transplantation, both in AHF and in Primary Non Function (PNF) cases.The recirculating molecular adsorption system (MARS), whose only function is to depurate through a "hybrid" membrane removing toxic substances related to albumin, has advantage in that it can be used for long periods. The aim of this study is to report on our experience in the use of MARS on 10 AHF patients (4 PNF, 2 delayed non function, 4 fulminant hepatitis). The average age was 41,8 years (range 23-56), 6 were male, 4 female. All had bilirubin 8805; 15 mg/ dl and ammonia 8805; 160 g/dl. MARS was applied for 8 € 1,5 hours a day. The average number of treatments was 6,4 (range 1-24).The EEG, hepatic and renal parameters were monitored before and after the treatment, while the hemodynamic parameters were monitored during the treatment.No hemodynamic complications occured during the treatment. A significant reduction in bilirubin (p < 0,01) and ammonia (p < 0,01) was observed. the average INR level at the onset of treatment was 2,05, at the end 1,59. After the treatment there was an improvement in neurological conditions. Three of the PNF patients recovered function of the transplanted organ and survived without further transplantations. The same applies for the two patients with delayed non function. All fulminant hepatitis patients were successfully bridged to transplantation, three subsquently died from complications, one was discharged in good condition.On the basis of our preliminary studies, the MARS treatment was found to be safe with a high tolerance rate, having a role in AHF treatment as bridge to liver transplantation or waiting for the graft to recover its functionality.

Surgery--namely, suture closure-is still the treatment of choice for perforated peptic ulcers, despite the proven efficacy of Taylor's conservative approach. Such conservative management, however, has been proven less effective in high-risk patients and those with perforations more than 12 h old. Here we suggest alternative laparoscopic treatments for perforated peptic ulcers. We have treated laparoscopically six patients (one F, five M; mean age 57.6 years; range 31-81 years); the mean duration of the operation was 52 min; the median hospital stay was 7 days (6-15 days); H2-blockers, antibiotics, and fluids were administered in the p.o. course; the follow-ups range from 6 to 18 months. On the basis of our experience, the treatment of choice for perforated peptic ulcers is Taylor's conservative procedure and laparoscopic drainage of the abdominal cavity when there is mild peritoneal reaction (usually less than 6 h from the onset of perforation). In case of remarkable peritonitis (usually more than 12 h), it is mandatory to add an accurate lavage. When the site of perforation is concealed by the peritoneal inflammation it should not be searched; when visible, it might be obliterated with the round ligament or an omental tissue strand, particularly if larger than 1 cm in diameter.