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A J Pesce

Publications and source records attributed to A J Pesce.

131 records · Page 8Linked to original sources
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Efficacy and safety of constant-rate intravenous cyclosporine infusion immediately after heart transplantation.

Oral cyclosporine therapy immediately after heart transplantation is erratic and difficult to predict. The purpose of this study was to evaluate the relative efficacy and safety of cyclosporine when administered by constant-rate infusion immediately after transplantation. Nineteen patients (17 men and two women) aged 50 years (range 25 to 61 years) who weighed 71 +/- 9 kg, participated in the study and received cyclosporine, 7 to 10 mg/hr (117 +/- 15 micrograms/kg/hr). The infusions were initially maintained for 26 +/- 5 hours (range 18 to 42 hours) without adjustments in dosage. Whole blood samples were obtained at hourly intervals for the first 8 to 12 hours and then daily throughout the 7-day study period and were analyzed by high-performance liquid chromatography. Constant-rate cyclosporine infusion resulted in therapeutic blood levels (350 to 450 ng/ml) at 6 hours. These levels remained relatively steady throughout the 7-day infusion, requiring only minimal dosage adjustments. Kidney function was not altered significantly after 7 days of intravenous cyclosporine therapy as evidenced by a mean serum creatinine level of 1.3 mg/dl before therapy and 1.4 mg/dl after therapy. There, however, was a transient rise in serum creatinine level in most patients on the second or third day after transplantation that resolved without a reduction in cyclosporine dosage. The mean endomyocardial biopsy score at 1 week after transplantation was 0.1, and only four of the patients required additional immunosuppressive therapy to treat rejection during the first 6 weeks after transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Hemoglobin by first derivative spectrophotometry: extent of hemolysis in plasma and serum collected in vacuum container devices.

Commonly obtained clear plasma or serum samples contain small amounts of hemoglobin derived from either naturally occurring processes or from collection trauma. Using the recently evaluated, highly specific, sensitive, quantitative procedure of first derivative spectroscopy, the hemoglobin concentration in nine types of vacuum collection containers was measured, including three types of anticoagulant, three tube sizes, and tubes with or without serum separators. Using this procedure, reference values were established for plasma and serum hemoglobin. These values are the result of the combined effect of red cell trauma during the collection, interaction with the anticoagulant or the serum separator material, and physiologic changes. The observed hemoglobin levels were best described by a log normal distribution pattern. The three plasma collection samples showed lower average values than the serum samples. The citrate anticoagulant gave the lowest plasma hemoglobin average value of 32.7 mg per L (3.27 mg per dl) 9.2 to 123 mg per L (0.92 to 12.3 mg per L 2SD range). It is concluded that the average hemoglobin concentration owing to the collection procedure is less than 100 mg per L (10 mg per dl). A serum or plasma hemoglobin concentration over 200 mg per L (20 mg per dl) is probably due to abnormal physiologic causes and not collection artefact. Serum or plasma hemoglobin measurements evaluated by these criteria can be relied upon as an accurate approximation of excess hemoglobin produced by a pathologic hemolytic process such as acute autoimmune hemolytic anemia, major blood group incompatibility or paroxysmal hemoglobinuria.

Blood Specimen Collection↗
PubMedDate not supplied

Use of cyclosporine and ketoconazole without nephrotoxicity in two heart transplant recipients.

A cyclosporine-ketoconazole drug interaction was first described in 1981. It has been suggested that the two drugs should not be used concomitantly because of the danger of severe nephrotoxicity. Two reported cases indicate that cyclosporine and ketoconazole can be safely coadministered, provided that the dosage of cyclosporine is reduced appropriately. Two patients were initially given 8 mg/kg/day of cyclosporine at the time of heart transplantation, and the dosage was tapered to meet appropriate blood levels (250 to 350 ng/ml by whole blood high-performance liquid chromatography). During ketoconazole therapy (400 mg daily for 4 weeks), patient 1 received 80 to 100 mg/day of cyclosporine, which is equal to approximately 1 mg/kg/day, and patient 2 received between 40 and 80 mg/day of cyclosporine, which is equivalent to 0.4 to 0.8 mg/kg/day. Neither patient exhibited a creatinine value above 1.4 mg/dl while on combined therapy, and there were no problems with allograft rejection. Both patients had inappropriately high cyclosporine blood levels even with this marked reduction in dosage (patient 1, 520 to 1310 ng/ml and patient 2, 320 to 600 ng/ml). Thus it appears that cyclosporine and ketoconazole can be administered together safely, provided that there is an appropriate reduction in the dosage of cyclosporine; this results in the maintenance of adequate immunosuppression without development of nephrotoxicity.

Cyclosporins↗