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Cyclosporine's narrow therapeutic window and the large inter- and intra-individual variation of its pharmacokinetics require therapeutic monitoring. Cyclosporine is metabolized in the liver and excreted with its metabolite into the bile. An accumulation of metabolites occurs in liver dysfunction, leading to a high cyclosporine blood concentration when measured by a non-specific method (polyclonal antibodies). Specific methods (HPCL, monoclonal antibody) are therefore recommended by some authors. We evaluated the potential usefulness of simultaneous cyclosporine determination by a non-specific (fluorescent polarisation TDx, polyclonal antibodies) and a specific method (I125-RIA, monoclonal antibody). 10 patients were followed from 51 days to 32 months after hepatic transplantation. 2 patients who showed no graft rejection presented a polyclonal antibodies/monoclonal antibody ratio below or equal to 4 throughout their evolution. Other patients presented a rise of this ratio during periods of liver dysfunction, particularly in acute graft rejection. When bilirubin concentrations are plotted versus this ratio, an hysteresis is present during periods of acute rejection, but not during an episode of histological hepatitis. The same holds true for alkaline phosphatase and gamma-GT. These data suggest that this ratio could be a sensitive test for early detection of rejection. Simultaneous cyclosporine blood determination with specific and nonspecific methods may be useful in the follow-up of liver-transplanted patients.

A health promotion and screening program for the detection of the major risk factors for ischemic heart disease was carried out in 1990 among the employees (n = 4,521; 70% female) of the Centre Hospitalier Universitaire Vaudois (CHUV). The prevalence of risk factors among the 1,425 employees (73% female) who took part in the study (participation rate: males 29%, females 33%) was compared with the prevalence of risk factors within three other populations: 1) new CHUV employees, who are systematically screened (n = 424: 71% female); 2) a representative sample of the general population; and 3) a group of employees from 44 companies located in the same region. Smoking was the most common of the three main risk factors; its prevalence was lowest among CHUV employees and highest among employees of the 44 firms. The prevalence of hypercholesterolemia and high blood pressure was variable among the different populations. These variations could partly be due to differences in methodologies and measurement conditions, but could not totally be explained in this way.

This paper presents the results of the first 7 orthotopic liver transplants performed in Lausanne between December 1988 and September 1990. 6 patients are surviving; their rehabilitation is excellent.

As part of the Swiss National Research Programme on Primary Prevention of Cardiovascular Diseases, plasma cholesterol was determined in 7947 adults of all ages. The distribution of the values obtained in the four Swiss cities investigated is given by age, sex and nationality. Percentile graphs of the whole sample show the influence of age for each sex. On the basis of these results it is estimated that amongst people aged 16-69 years living Switzerland, 7.4% of the men and 8.4% of the women can be expected to have a plasma cholesterol level above 280 mg/dl (7.25 mmol/l). The different relationships between plasma cholesterol and other factors such as consumption of tobacco or alcohol and body mass index were investigated. The latter shows a significant correlation coefficient (r = 0.2, p less than 0.001) for each sex, for the age group 25-44 and for each of the cities. Alcohol consumption is also directly associated with total blood cholesterol. The role of this factor is discussed in relation to the differences in plasma cholesterol observed between the cities.