Excellent intubating conditions with remifentanil–propofol and either low-dose rocuronium or succinylcholine

Purpose

The shortest time to tracheal intubation, the best intubating conditions, and the shortest duration of muscle paralysis are achieved with succinylcholine. During a lidocaine–remifentanil–propofol induction of anesthesia, we compared intubating conditions 90 s after administering low-dose rocuronium (0.3 mg · kg^?1) with intubating conditions 60 s after administering succinylcholine 1.5 mg · kg^?1.

Methods

The randomized double-blind study included 184 healthy adult patients scheduled for elective surgery. Anesthesia was induced in all patients with lidocaine 1.5 mg · kg^?1, remifentanil 2 μg · kg^?1, and propofol 2 mg · kg^?1 administered over 30 s. In one group, rocuronium 0.3 mg · kg^?1 was administered before the induction sequence, and in the other group, succinylcholine 1.5 mg · kg^?1 was administered after the induction sequence. Laryngoscopy was attempted 90 s after rocuronium administration and 60 s after succinylcholine administration. Intubating conditions were assessed as excellent, good, or poor on the basis of ease of laryngoscopy, position of the vocal cords, and reaction to insertion of the tracheal tube and cuff inflation.

Results

There were 92 patients per group. In the rocuronium group, intubating conditions were excellent in 83 patients (90%), good in 8 (9%), and poor in 1 (1%), not significantly different from the intubating conditions in the succinylcholine group, which were excellent in 88 patients (96%), good in 3 (3%), and poor in 1 (1%) (P = 0.3).

Conclusion

During a lidocaine–remifentanil–propofol induction of anesthesia, rocuronium 0.3 mg · kg^?1 administered before the induction sequence provides intubating conditions comparable to those achieved with succinylcholine 1.5 mg · kg^?1 administered after the induction sequence.     

Cytotoxicity assessment of latex urinary catheters on cultured human urothelial cells

PURPOSE: To study the toxicity of latex urinary catheters on cultured human urothelial cells (HUC). MATERIALS AND METHODS: We exposed monolayers of HUC (well characterized for their proliferation, qualitative evaluation and quantitative measurement of cytokeratins) to either pure or diluted liquid latex extracts, obtained under standard conditions or by direct contact with materials. RESULTS: The latex urinary catheter appears to be highly toxic since cell viability and metabolic activity were about 10% of those of negative controls for original extracts. Concerning direct contact, latex reduced cell viability, metabolic activity and cell proliferation of HUC on days 1, 3 and 8. CONCLUSION: The high toxicity of latex on HUC is confirmed for extracts and direct contact. Therefore, it should no longer be used for urinary catheters.     

In vitro study of the hemocompatibility of superparamagnetic contrast agent for magnetic resonance imaging

Five different nanoparticles, potentially useful in magnetic resonance imaging (MRI) after venous administration, were studied for their hemocompatibility. The in vitro methodology evaluated these materials by several parameters: cytotoxicity towards cells cultured in vitro, aggregation ability of platelets, hemolysis inducibility, intrinsic and extrinsic coagulation pathway activation, and complement activation. With the proposed clinical dose, regardless of the cell type used (murine cell line or human endothelial cells) no toxicity was observed. The presence of the particles in blood did not produce any considerable damage: either hemolysis or platelet aggregation or blood coagulation were recorded. However, a slight decrease in aggregation ability of platelets was noticed as well as an increase in partial thromboplastin time. Because of the quick removal of the particles from the bloodstream, these phenomena must be short-lived, thus avoiding significant adverse clinical effects.     

Whatever their differentiation status,human progenitor derived – or mature – endothelial cells induce osteoblastic differentiation of bone marrow stromal cells

Association of the bone‐forming osteoblasts (OBs) and vascular endothelial cells (ECs) into a biomaterial composite provides a live bone graft substitute that can repair the bone defect when implanted. An intimate functional relationship exists between these cell types. This communication is crucial to the coordinated cell behaviour necessary for bone development and remodelling. Previous studies have shown that direct co‐culture of primary human osteoprogenitors (HOPs) with primary human umbilical vein endothelial cells (HUVECs) stimulates HOPs differentiation and induces tubular‐like networks. The present work aims to test the use of human bone marrow stromal cells (HBMSCs) co‐cultured with human endothelial progenitor cells in order to assess whether progenitor‐derived ECs (PDECs) could support osteoblastic differentiation as mature ECs do. Indeed, data generated from the literature by different laboratories considering these co‐culture systems appear difficult to compare. Monocultures of HUVECs, HOPs, HBMSCs (in a non‐orientated lineage), PDECs (from cord blood) were used as controls and four combinations of co‐cultures were undertaken: HBMSCs–PDECs, HBMSCs–HUVECs, HOPs–PDECs, HOPs–HUVECs with ECs (mature or progenitor) for 6 h to 7 days. At the end of the chosen co‐culture time, intracellular alkaline phosphatase (ALP) activity was detected in HOPs and HBMSCs and quantified in cell extracts. Quantitative real‐time polymerase chain reaction (qPCR) of ALP was performed over time and vascular endothelial growth factor (VEGF) was measured. After 21 days, calcium deposition was observed, comparing mono‐ and co‐cultures. We confirm that ECs induce osteoblastic differentiation of mesenchymal stem cells in vitro. Moreover, HUVECs can be replaced by PDECs, the latter being of great interest in tissue engineering. Copyright © 2012 John Wiley & Sons, Ltd.     

In patients with type 1 diabetes simultaneous pancreas and kidney transplantation preserves long-term kidney graft ultrastructure and function better than transplantation of kidney alone

Aims/hypothesis

In patients with type 1 diabetes and end-stage renal disease (ESRD) we aimed to determine whether long-term normoglycaemia, as achieved by successful simultaneous pancreas and kidney (SPK) transplantation, would preserve kidney graft structure and function better than live donor kidney (LDK) transplantation alone.

Methods

Estimated GFR (eGFR) was calculated in SPK (n?=?25) and LDK (n?=?17) recipients in a stable phase 3 months after transplantation and annually during follow-up. Kidney graft biopsies were obtained at follow-up for measurement of glomerular volume (light microscopy), glomerular basement membrane (GBM) and podocyte foot process widths and mesangial volume fraction (electron microscopy).

Results

SPK and LDK recipients were similar in age and diabetes duration at engraftment. Donor age was higher in the LDK group. Median follow-up time was 10.1 years. Mean HbA_1c levels during follow-up were 5.5?±?0.4% (37?±?5 mmol/mol) and 8.3?±?1.5% (68?±?16 mmol/mol) in the SPK and LDK group, respectively (p?p?=?0.008) and increased mesangial volume fraction (median 0.23 [range 0.13–0.59] vs 0.16 [0.10–0.41]; p?=?0.007) at follow-up. Absolute eGFR change from baseline was ?11?±?21 and ?23?±?15 ml min^?1 1.73 m^?2 (p?=?0.060), whereas eGFR slope was ?1.1 (95% CI ?1.7, ?0.5) and ?2.6 (95% CI ?3.1, ?2.1)?ml min^?1 1.73 m^?2 per year in the SPK and LDK group, respectively (p?=?0.001).

Conclusions/interpretation

In patients with type 1 diabetes and long-term normoglycaemia after successful SPK transplantation, kidney graft ultrastructure and function were better preserved compared with LDK transplantation alone.     

Liver damage and nonsteroidal anti-inflammatory drugs: case non-case study in the French Pharmacovigilance Database

This study investigates the relationship between exposure to non-steroidal anti-inflammatory drugs (NSAIDs) and liver injuries using the French Pharmacovigilance Database. We use the case/non-case methodology, where 'cases' were reports of the reactions of interest (liver injuries as recorded in the database according to the WHO-ART classification including cytolytic and cholestatic hepatitis, acute hepatitis, liver enzyme elevations). 'Non-cases' were all reports of reactions other than these being studied. Amineptine and acetaminophen were used as 'positive controls'. Among the 42,913 adverse drug reactions recorded in the database between January 1995 and December 1997, 5708 (13 per cent) were liver injuries. In comparison with other drugs in the database, liver injuries were inversely associated with exposure to NSAIDs, whatever the class of the drugs (OR 0.3 [0.3-0.4]). In contrast, liver injuries were significantly related to acetaminophen (OR 2.1 [1.9-2.3]), and amineptine (OR 14.0 [10.5-18.7]). Naproxen and diclofenac were associated with a higher frequency of liver injuries, respectively 15.7 per cent and 11.5 per cent. The risk associated with NSAIDs alone significantly decreased when the analysis was performed after exclusion of hepatotoxic drugs associated with NSAIDs (except for naproxen). The present results show the low frequency of liver damage associated with NSAIDs. The main factor appears to be concomitant exposure to other hepatotoxic drugs.     

Growth hormone treatment without a needle using the Preci-Jet 50 transjector

A new delivery system (Preci-Jet 50) which administers growth hormone through the skin using high pressure and without a needle was evaluated. This device was inconvenient and painful compared with a pen injection system. The conclusion is that the Preci-Jet is not the panacea for solving the problem of compliance with subcutaneous growth hormone injections.