Aerosolisation of beclomethasone dipropionate using spray dried lactose/polyethylene glycol carriers.

The aim of this study was to characterize the physical properties of spray dried lactose in the presence of different polyethylene glycols (PEG 400, PEG 3000 and PEG 6000) and to evaluate their performance as carriers for dry powder inhaler (DPI) formulations. The efficiency of spray dried lactose/PEG carriers in aerosolisation of beclomethasone dipropionate (BD), a model hydrophobic drug, was compared to Pharmatose 325 M (L325), spray dried lactose alone (SDL), and also a sieved (< 38 microm) fraction of alpha-lactose monohydrate (SL). In vitro deposition analysis was performed using a twin stage liquid impinger at a flow rate of 60 l/min through a Spinhaler. The deposition profiles of the drug from binary formulations composed of BD and spray dried lactose/PEG carriers were also compared to ternary formulations containing large and fine lactose carriers. Differential scanning calorimetry and X-ray diffraction data showed the presence of alpha-anhydrous lactose in spray dried lactose/PEG crystalline powders. Spray drying of lactose in the presence of PEG 400 resulted in the production of a powder (SDL-PEG400) with lower alpha-lactose monohydrate content, and also smaller particle size distribution than those obtained in the presence of PEG 3000 (SDL-PEG3000) or PEG 6000 (SDL-PEG6000). All formulations showed different deposition profiles, except those containing SDL-PEG3000 or SDL-PEG6000 which exhibited similar data. The fine particle fraction of aerosolised BD varied from 6.26 +/- 1.07 (for L325) to 25.87 +/- 5.33 (for SDL-PEG3000). All deposition profiles of BD aerosolised from SDL-PEG3000 were significantly higher (P < 0.01) than those produced by binary and ternary formulations containing L325, a coarse lactose commercially available for DPI formulations. The differences observed in deposition data for various carriers were interpreted according to their physical properties. It was concluded that particle size distribution, morphology and specific surface texture of SDL-PEG3000 and SDL-PEG6000 were important factors influencing their efficiency as small carriers for DPI formulations.     

Not-to-tap cystic lesions: spectrum of hydatid disease

Hydatid disease (HD) may occur almost anywhere in the body. Despite their characteristic radiologic manifestations at times, they may enlarge and produce bizarre imaging features which make diagnosis challenging, particularly for those radiologists working in areas of low incidence. Plain radiography, ultrasonography, computed tomography, and magnetic resonance imaging may demonstrate some of the typical imaging manifestations of HD as well as its exact extension. On the other hand, particular caution is required before any kind of interventions to be done in that biopsy or aspiration of such lesions may cause devastating consequences, in particular anaphylactic shock. Hence, being familiar with various radiologic features of HD is essential in improving diagnostic accuracy and also preventing adverse reactions in these patients. The purpose of this pictorial review is to illustrate the different radiological features of HD in various organs.     

Modeling the macro-structure of the heart: healthy and diseased

In a common heart pathology, dilated cardiomyopathy, the ventricular chamber undergoes a complex remodeling that changes the shape of the ventricle and the architecture of the fibers in the myocardium. In order to effectively surgically reconstruct the heart it is necessary to understand the relative impact of these changes on heart function. Here we present a series of simulations that model different pathological changes separately. We use the sensitive relationship between twist of the ventricle and its ejection fraction to judge the functional impact of the different damage types. We show that the anomalies found in the relation between torsion and ejection fraction for dilated cardiomyopathy are predominantly caused by the damage to the architecture of the myofibrils of the heart, rather than gross geometry.     

Cardiovascular residual risk assessment in patients undergoing therapy: A combined structural and functional approach

While imaging of coronary artery calcium (CAC) and carotid intima media thickness (CIMT) is being increasingly used for cardiac risk stratification, residual risk after treatment has relied on changes in lipid values. Unfortunately, there is no clear relationship between post-treatment lipids and event reduction, as evidenced by the persistently high event rates despite significant lipid modification. A new approach, combining changes in subclinical atherosclerosis with inflammatory and endothelial function parameters of disease activity, may offer a better alternative. Imaging technologies include CAC, CIMT, MRI, molecular imaging, and coronary CT angiography. High-sensitivity C-reactive protein and lipoprotein-associated phospholipase A2 are the most commonly used inflammatory markers. Endothelial function techniques include venous occlusion plethysmography, ultrasound flow-mediated dilation, pulse wave and contour analysis, peripheral arterial tonometry, and digital thermal monitoring. This article presents the various modalities and combinations of imaging and activity/endothelial function, as well as clinical recommendations and testing intervals.     

The effect of three positioning methods on patient outcomes after cardiac catheterization

Title.  The effect of three positioning methods on patient outcomes after cardiac catheterization.
Aim.  This paper is a report of a study to investigate the effect of three positioning protocols on back pain, heart rate, blood pressure and vascular complications after cardiac catheterization.
Background.  After cardiac catheterization, bed rest is prescribed in order to minimize vascular complications, but this often leads to back pain and other complications, such as hemodynamic instability.
Methods.  A three-group quasi-experimental design was used in this study, which was conducted in 2006. A convenience sample of 105 patients was randomly assigned to either the control or the two experimental groups (A and B). The control group received routine care. Group B was treated only with modified positioning and group A with modified positioning and a pillow under their body. Back pain, heart rate, arterial blood pressure, haematoma formation and bleeding were measured at regular time intervals.
Findings.  The control group experienced higher levels of pain after 3, 6, 8 hours and the morning after catheterization. The level of pain in group B was also higher than in group A at 3 hours after the procedure. Mean heart rate and blood pressure were lower in the experimental groups compared with the control group at 6 and 8 hours after catheterization. No statistically significant difference between the three groups regarding the amounts of overall bleeding and overall haematoma formation was observed.
Conclusion.  Changing position in bed and using a supportive pillow during the early hours after cardiac catheterization can effectively minimize pain and hemodynamic instability without increasing vascular complications.     

Atrophy of the quadriceps muscle in children with a painful hip

The objective of this study was to determine the degree of muscle wasting of various components of the quadriceps muscle in children with a painful hip. Between January 1994 and September 1997, 327 consecutive children with a unilateral painful hip and/or limping were evaluated prospectively with ultrasonography. Quadriceps thickness was measured on both sides. Moreover, muscle thickness was measured in 59 control subjects. The patients were divided into eight groups; transient synovitis (n=134), Perthes’ disease (n=35), slipped capital femoral epiphysis (n=5), osteomyelitis (n=4), aspecific synovitis (n=5), rheumatoid arthritis (n=3) and miscellaneous (n=16). In 125 patients, no sonographic and radiological abnormalities were found and during follow-up the symptoms disappeared (‘no pathology’ group). Ipsilateral muscle wasting was present in all patient groups, whereas the control subjects showed no significant difference in muscle thickness between legs. The degree of muscle wasting was compared between transient synovitis, the ‘no pathology’ group, Perthes’ disease and control subjects. For both quadriceps and vastus intermedius muscles, there was a significant difference between these groups, except between control subjects and the ‘no pathology’ group. For the rectus femoris muscle, there was a significant difference between these groups, except between transient synovitis and ‘no pathology’. Muscle wasting showed a positive correlation with duration of symptoms and pre-existing muscle mass. In conclusion, different diseases show different degrees of muscle wasting, and there are different patterns of muscle wasting of various components of the quadriceps femoris muscle.