Microscopic colitis associated with lansoprazole: Report of two cases and a review of the literature

Microscopic colitis causes chronic watery diarrhea. Many cases may be induced by medications, and lansoprazole, a commonly used proton-pump inhibitor, has been associated with collagenous colitis and lymphocytic colitis, the two subtypes of microscopic colitis. Two cases of collagenous colitis associated with lansoprazole are reported, both in older female patients, who each developed profuse watery diarrhea within weeks of starting lansoprazole to treat upper digestive disorders. Colonoscopy was normal and biopsies demonstrated typical features of collagenous colitis. There was a rapid clinical improvement upon switching from lansoprazole to rabeprazole, and histological normalization on follow-up biopsies. A review of the literature showed 14 other cases of lansoprazole-related microscopic colitis. There are no reported cases of microscopic colitis associated with other proton-pump inhibitors, suggesting a pathophysiologic mechanism specific to the pharmacology of lansoprazole. Clinicians must be aware of this association when prescribing this medication; when a patient taking lansoprazole develops diarrhea, substituting an alternative proton-pump inhibitor should allow resolution of the diarrhea.     

Management of hepatocellular adenoma: comparison of resection,embolization and observation

Introduction

Hepatocellular adenoma (HA) is an uncommon benign hepatic tumour with the potential for malignant change or spontaneous haemorrhage. Resection has been the recommended treatment, but outcomes with other approaches are ill defined.

Methods

Demographic and outcomes data were retrospectively collected on patients diagnosed with HA at a tertiary hepatobiliary centre from 1992–2011 whom underwent resection, bland embolization or observation.

Results

In total, 52 patients with 100 adenomas were divided into single HA (n = 27), multiple HA (n = 18), and adenomatosis (n = 7) groups. Eighty-seven per cent were female and 37% had a history of hormone use. Median sizes of resected, embolized and observed adenomas were 3.6 cm, 2.6 cm and 1.2 cm, respectively. Forty-eight adenomas were resected as a result of suspicion of malignancy (39%) or large size (39%); 61% of these were solitary. Thirty-seven were embolized for suspicion of malignancy (56%) or hsemorrhage (20%); 92% of these were multifocal. Two out of three resected adenomas with malignancy were ≥10 cm and recurred locally [4%, confidence interval (CI) 1–14%]. Ninety-two per cent of the embolized adenomas were effectively treated; three persisted (8.1%, CI 2–22%). Most observed lesions did not change over time.

Conclusions

While solitary adenomas are often resected, multifocal HAs are frequently embolized. Small adenomas can safely be observed. Given low recurrence rates, select HAs can be considered for embolization.     

The development of colour-encapsulated microspheres for novel colour cosmetics

In the present study, the preparation, characterization and colour retention properties of organic colour-loaded microspheres are described. The study aimed to produce shatter-resistant, low-bleeding polymeric microspheres with particle diameters of 20 µm containing 10–20% (w/w) of the Food, Drug, and Cosmetic grade colourants FD&C Blue No. 1 Al Lake, FD&C Yellow No. 5 Al Lake and D&C Red No. 36 by utilizing an aqueous-dispersed polymer water-in-oil (W/O) solvent evaporation process featuring styrene/acrylates-based copolymers. The influences of matrix polymeric components on the shape, integrity and dye retention of the microspheres were studied. Encapsulation matrices based on alkali soluble polymers yielded misshapen spheroids that were prone both to swelling and decreased dye retention in aqueous environments, as well as loss of shape at 70°C in cosmetic oils under shear. A resin supported emulsion (RSE)-based matrix, in comparison, yielded highly spherical microspheres resistant to shape deformation and swelling. Additions of up to 15% (w/w) of an alkali soluble polymer to the RSE system improved colour dispersion without detrimentally affecting the structural integrity of the microspheres while also slightly decreasing dye concentrations released into aqueous solutions. The in vitro dye release of the colour-loaded microspheres in a cosmetic-type water-in-silicone (W/Si) emulsion was evaluated and compared to the in vitro dye release studies in aqueous solutions. No direct correlations between the emulsion system and single-component aqueous solutions could be made. Dye-release levels evaluated from contacting the microspheres with a complex aqueous medium (CAM5), which incorporated ingredient classes typically encountered in the aqueous phase of an emulsion, were found to correlate to levels determined in the generic W/Si emulsion with a 93% linear regression between the data sets. This study demonstrates that the CAM5 protocol (or, alternatively, a CAM2.5 protocol) satisfactorily predicted that the commercial materials derived, in part, from this study (Ciba: ENCAPSULENCE? Blue 1, ENCAPSULENCE? Yellow 5 and ENCAPSULENCE? Red 36) are well suited to retain their colour and shape in liquid cosmetic foundations.     

Novel 4H-1,2,4-triazol-3-yl cycloalkanols as potent antitubercular agents

Enzymes of shikimate pathway, dehydroquinase and shikimate kinase represent comparatively newer targets for antitubercular research. Molecular hybridization approach was implemented by integrating the essential features of inhibitors acting on these enzymes of shikimate pathway. Considering the flexibility of alicyclic ring of reported dehydroquinase (DHQ) inhibitors and triazole ring, key feature of the virtual hits of Mtb shikimate kinase, a series of structurally novel, substituted 4H-1,2,4-triazol-3-yl cycloalkanols were designed as antimycobacterial agents. Docking studies of the molecules was carried out on the enzyme DHQ. All the synthesized compounds exhibited promising activity (MIC 0.59–15.5 μg/ml) against H₃₇Rv strains of Mycobacterium tuberculosis using resazurin microtiter assay. Five of the evaluated compounds exhibit MIC < 1 μg/ml. CC₅₀ values indicate compounds are non-toxic, with selectivity indices >28. These compounds could serve as leads for further optimization to obtain novel antimycobacterial agents.     

Synthesis and in vitro antimicrobial and anti-tubercular evaluation of some quinoline-based azitidinone and thiazolidinone analogues

Keeping the objective to build up a new structural class of potent antimicrobials and antituberculosis agents, a series of potentially active quinoline-based azetidinone and thiazolidinone analogues has been synthesized by a simple and efficient synthetic protocol. The thione nucleus formed from 2-chloroquinoline-3-carbaldehyde using sodium sulphide in DMF followed by reaction with various substituted amine to form the corresponding Schiff base intermediates. Attempt has been made to derive final azetidinone and thiazolidinone analogues from Schiff bases by using chloroacetyl chloride and 2-mercapto acetic acid, respectively. Newer analogues were characterized by IR, ¹H NMR, ¹³C NMR spectroscopy and elemental analyses. The newly synthesized analogues were then examined for their antimicrobial activity against some bacterial and fungal strains as two Gram ?ve bacteria (Escherichia coli MTCC 739, Pseudomonas aeruginosa MTCC 741), two Gram +ve bacteria (Staphylococcus aureus MTCC 96, Bacillus subtilis MTCC 430) and two fungal species (Aspergillus niger MTCC 282, Candida albicans MTCC 183) to develop a novel class of antimicrobial agents and The final compounds were tested for in vitro antituberculosis activity against Mycobacterium tuberculosis. Streptomycin, Isoniazid, Rifampicin and Ethambutol were used as standards in this test. These observations provide some predictions to design further antibacterial and antituberculosis active compounds prior to their synthesis according to molecular modeling studies.     

Maximal flow rates possible during power injection through currently available PICCs: an in vitro study

PURPOSE: Currently available 4-F and 5-F peripherally inserted central catheters (PICCs) were investigated to evaluate their possible application for contrast medium injection using power injectors. The study was performed using an in vitro model to demonstrate the feasibility of using PICCs for contrast-enhanced diagnostic studies. MATERIALS AND METHODS: An evaluation of 24 catheter versions consisting of 4-F single-lumen and 5-F dual-lumen PICCs from 13 different manufacturers was conducted. Six of the catheter types were silicone and 18 catheter types were polyurethane. Ten catheters of each type were evaluated with five at full length and five trimmed to 40 cm. With use of a silicone-based simulated SVC model, the catheters were infused with 50 mL of intravenous contrast medium at each flow rate increment. Catheters were tested at increasing flow rates from 0.5 to 5 mL/sec in 0.5-mL/sec increments using a Percupump CT injector. Catheters that failed to rupture were then infused at 1-mL/sec increments at flow rates from 5 to 17 mL/sec using a MedRad Mark V power injector. Tolerated and bursting pressures were recorded as well as the location of the catheter rupture. RESULTS: Polyurethane catheters ruptured at flow rates between 4 and 15.4 mL/sec, with one catheter not rupturing at the maximal flow rate (17 mL/sec). Silicone catheters ruptured at flow rates between 0.5 to 3.5 mL/sec. Average rupture locations by type and length were at the extension leg/hub connection area on five of the PICCs, on the extension legs on 21 of the PICCs, on the catheter/hub connection on four PICCs, and on the proximal catheter on 16 of the PICCs. CONCLUSION: The low burst rates at which all silicone catheters ruptured suggest that those catheters are not able to withstand typical flow rates used for CT arteriography. Conversely, although there is a wide range of discrepancy in the polyurethane catheter burst pressures, many polyurethane catheters can tolerate relatively high flow rates without rupture. This suggests that they may be safely used for CT arteriography with appropriate precautions and protocols in place.     

Correlation of Nasal Nitric Oxide Measurement with Computed Tomography Findings in Chronic Rhinosinusitis

Nitric oxide (NO) is a biological messenger produced by mammalian cells serving various functions including regulation of blood flow, platelet function, immunity, and neurotransmission. The paranasal sinuses and nasal mucosa are a major source of exhaled NO. The aim of the study is to compare the nasal NO (nNO) levels in patients with chronic rhinosinusitis with those of common cold patients and controls and to correlate CT scores with nNO levels. The nasal concentration of NO was measured by electroluminescence in 13 healthy volunteers, in 13 patients suffering from common cold and 13 patients with chronic rhinosinusitis. The concentration of NO was correlated with symptom scores, endoscopic findings and CT findings. The measured levels of NO did not differ between healthy volunteers and common cold patients, but they were significantly lower in patients suffering from chronic rhinosinusitis. As NO is a regulator of mucociliary activity and has bacteriostatic and antiviral effects, the decreased concentration of nNO in patients suffering from sinusitis suggests that lack of NO may contribute to the pathogenesis of this disease. Thus, nNO, which is easily measured, provides a valuable non-invasive objective measure of chronic rhinosinusitis.