Risk of Developing Fibroadenoma with the Use of Cyclosporine A in Renal Transplant Recipients

Cancer screening in people who have chronic disease: the example of kidney disease

Cancer screening in people with chronic illness has been the subject of considerable debate recently. Despite the increased incidence of cancer and higher risk of cancer deaths in selected populations, such as those with kidney disease, the benefits-to-harms ratio of cancer screening is uncertain and is likely to be different to people without chronic illnesses because of the expected higher competing risk of death from disease other than cancer, and a higher risk of complications associated with the screening, the diagnostic, and the treatment processes. Using kidney disease as an example, the authors reviewed the current evidence for early cancer detection through screening in people with two or more coexistent chronic diseases, discussed the accepted principles underpinning cancer screening, and the applicability of these concepts to individuals with chronic disease. This review suggests that future research that evaluates the screening test accuracy, quality of life of having cancer, and cancer treatment effectiveness, targeting those with chronic illnesses are necessary for the development of an effective, safe, and acceptable cancer screening program among people with two or more chronic diseases.

Safety and toxicology of cyclosporine in propylene glycol after 9-month aerosol exposure to beagle dogs

BACKGROUND

Cyclosporine inhalation solution (CIS) delivered via nebulization is under evaluation for the prevention of chronic rejection post-lung transplant. A 300-patient randomized, controlled clinical trial (CYCLIST) is expected to be completed late in 2011. In support of this trial, a chronic inhalation toxicology study in dogs has been completed.

METHODS

To mimic the clinical setting, animals (four/sex/dose plus two/sex/dose in the control and high dose recovery groups) were exposed to aerosolized CIS, via nose-only exposure, three times per week for 9 months at targeted inhaled doses of 0 (air), 4, 12, and 24 mg/kg. In addition, the potential for persistence or reversibility of any toxic effects were assessed after a 6-week recovery period. The toxicological endpoints included clinical observations, body-weight, food consumption, toxicokinetics, clinical chemistry, and histopathology.

RESULTS

All dogs receiving CIS completed the study with the only consistent observations being excessive salivation and changes in minute ventilation. There was no limiting lung or systemic toxicity associated with exposure to CIS, and the only possible drug-related effect was an observation of benign fibroadenoma tissue in the mammary glands of the high-dose female recovery group. Toxicokinetic data showed that cyclosporine is initially absorbed rapidly with little drug remaining in lung tissue or blood 24 h after the end of dosing.

CONCLUSION

The study supports the pulmonary and systemic safety of aerosolized CIS at expected lung dose levels/kg of up to 12 times greater than the average dose patients are receiving in the CYCLIST trial.

Imaging features of bilateral breast abnormalities

There are various-causes, broad-spectrum, heterogeneous groups with various biologic profiles, and imaging features of bilateral breast abnormalities. As imaging modalities continue to be developed, the ability to detect subtle or tiny abnormalities is improved in the contralateral breast of patients already diagnosed with unilateral breast disease, especially in breast cancer patients when using magnetic resonance imaging. Furthermore, some diseases involved bilateral breast, simultaneously. The purpose of this review is to describe imaging features of the bilateral breast abnormalities-common diseases and simultaneously involving diseases. In order to provide adequate treatment and to prevent misdiagnosis, a complete understanding of the imaging and clinical features of bilateral breast abnormalities of common diseases as well as those of simultaneously involving diseases is necessary.

Reversible Fibroadenomatous Mammary Hyperplasia in Male and Female New Zealand White Rabbits Associated with Cyclosporine A Administration

All male and female New Zealand white rabbits in a limbal cell graft study developed marked generalized mammary gland hypertrophy. Postprocedural medications included ophthalmic 0.1% dexamethasone, ophthalmic 0.5% cyclosporine, and subcutaneous cyclosporine A. Cytologic examination revealed epithelial clusters with minimal malignant criteria. On histologic evaluation, there was diffuse glandular hyperplasia with mild cellular atypia and ductal ectasia separated by abundant hypercellular fibrous stroma, consistent with fibroadenomatous mammary gland hyperplasia. The hyperplasia resolved within 2 weeks of cessation of cyclosporine, and at necropsy identifiable mammary masses were not found. Very little has been reported about the use of cyclosporine in laboratory rabbits and its association with development of mammary gland hyperplasia. This is the first report in which administration of cyclosporine to male and female rabbits at a dose as low as 5 mg/kg/day induced benign fibroadenomatous mammary gland hyperplasia. This change regressed after cessation of the drug.