Effects of replacing oxitropium with tiotropium on pulmonary function in patients with COPD: a randomized study

BACKGROUND: Inhaled bronchodilators are first line drugs in the treatment of chronic obstructive pulmonary disease (COPD). Tiotropium bromide is a recently introduced long-acting anticholinergic agent able to reduce dyspnoea and COPD exacerbations and to improve pulmonary function and quality of life. We designed a study to compare the short-term efficacy of tiotropium bromide with that of oxitropium bromide in improving pulmonary function in patients with COPD. METHODS: Eighty patients were randomized either to continue oxitropium 800 mcg/day or to receive tiotropium 18 mcg/day. Seventy-six (39 in the tiotropium and 37 in the oxitropium group) completed the study. Plethysmography was performed at baseline and after 72 h in all patients. The changes in functional parameters in the two groups were compared by the Mann-Whitney U-test. RESULTS: There were no differences between the two groups regarding age (72.5 vs. 74.2 years), male/female ratio (25/14 vs. 23/14) and pulmonary function at baseline. The changes in spirometric parameters were significantly greater in tiotropium- than in oxitropium-treated patients: mean forced expiratory volume in 1s (FEV(1)) increased significantly by 15% vs. 3% (P=0.017), mean FVC by 10.5% vs. 2.2% (P=0.044), and FEF 25, 50, and 75 by 34% vs. 14% (P<0.05), 33% vs. 7% (P<0.05), and 50% vs. 6% (P<0.0001), respectively; mean FRC and RV decreased nonsignificantly by 7.5% and 10% with tiotropium vs. 4.3% and 6.5% with oxitropium, respectively. CONCLUSION: The replacement of oxitropium with tiotropium significantly increases pulmonary function in patients with COPD. The improvement involves also small airways that have not been investigated thus far.     

Differential effect of cheese fatty acid composition on blood lipid profile and redox status in normolipidemic volunteers: a pilot study

The present study investigated the effect of the consumption of two cheese varieties differing for fat quality on blood lipid profile and redox status biomarkers in 30 selected healthy volunteers, consuming either the experimental cheese (from milk produced by cows fed a grass and maize silage based diet with 5% of linseed oil added) or the control cheese (from normal cows' milk) for 4 weeks according to a crossover design. The experimental cheese had a lower content of medium-chain saturated fatty acids and a higher content of stearic acid and polyunsaturated fatty acids; its consumption led to higher levels of vitamins C and E and stearic acid in blood, while myristic acid and oxidized low-density lipoprotein concentrations were significantly lower. As myristic acid and oxidized low-density lipoprotein are highly correlated with increased atherogenic risk and vitamins C and E with antioxidant activity, the enrichment of cows' diet with linseed oil could provide a dietary option to prevent cardiovascular diseases risk.     

Bronchodilators modulate inflammation in chronic obstructive pulmonary disease subjects

Chronic obstructive pulmonary disease (COPD) is characterized by neutrophilic airway inflammation and oxidative stress. Leukotriene B(4) (LTB(4)), a potent proinflammatory mediator, is synthesized by 5-lipoxygenase (5-LO), which is activated by the presence of lipid hydroperoxides resulting from oxidative stress on biological membranes. We proposed to evaluate the effect of a four week treatment with two different bronchodilators of common practice in COPD treatment, on the production of reactive oxygen species (ROS), in particular superoxide anions, and of LTB(4) by peripheral blood neutrophils obtained from COPD subjects. 24 subjects among the COPD outpatients were enrolled, and randomized to receive either formoterol (12μg bid) or tiotropium (18μg od). Peripheral blood neutrophils were obtained at the start and at the end of the treatment, and production of superoxide anions and of LTB(4) were evaluated as previously published. The results obtained showed a decrease in the unstimulated production of superoxide by isolated neutrophils in both groups, but tiotropium only was effective in modulating the production of LTB(4), while formoterol caused an increased production of superoxide in response to fMLP, when compared to values obtained before treatment. In conclusion, tiotropium showed a better antiinflammatory activity profile when compared to formoterol in a clinical setting, reducing superoxide and LTB(4) production by peripheral neutrophils obtained from COPD subjects.     

Epidural analgesia in children: planning, organization and development of a new program

BACKGROUND: The goal of the present work is to describe the development and results of the pediatric epidural analgesia program at the 'Hospital Nacional de Pediatria Prof. Dr. J. P. Garrahan' in Argentina. METHODS: Patients with thoracotomy, abdominal surgery, osteotomy, amputations or severe trauma were included in the program. The program provided training to the entire staff, control and record of pain treatment and its consequences, 24 h a day availability of anesthesia staff and standard polices and procedures. RESULTS: One hundred fifty children under 16 years of age (median age 11 years, median weight 35 kg) were included in the program during the first 18 months. The median of maximum pain reported during activity was 1 (interquartile range 1 to 4 points) using the Visual Analogue Scale (VAS) or Objective Pain Scale (OPS). Eighty seven children (CI 95% 50% to 67%) presented with postoperative nausea and vomiting, urinary retention, itching, motor blockade or sedation. No patient presented with respiratory depression, hypotension, local anaesthetic toxicity, epidural catheter related infection or death during the program evaluation. The postoperative care program enabled a 98-day reduction in treatment in the intensive care unit. CONCLUSION: The safe use of pediatric epidural analgesia in general wards may require the careful selection of patients, systematic assessment by trained personnel, training of medical and nursing personnel, clear distribution of responsibilities, use of printed indications, systematic record of pain, sedation and complications, information and education of patients and parents, supply of systems for airway resuscitation and management and continuous quality control and revision of the methods.     

Persistent dysphagia after laparoscopic fundoplication

Postoperative dysphagia is an important complication after fundoplication for reflux disease, sometimes requiring re-operation. The aim of this retrospective study was to analyse our results after fundoplication performed for gastro-oesophageal reflux disease in order to assess the incidence of postoperative dysphagia, its therapy and the results in the treatment of this complication. We analysed the data of 276 patients who underwent fundoplication for gastro-oesophageal reflux disease. 8.7% of the patients had preoperative dysphagia and 9.1% had major postoperative dysphagia, during the follow-up. No correlation was found between preoperative and persistent postoperative dysphagia. Among patients with persistent postoperative dysphagia, 8 underwent endoscopic pneumatic dilatation, with symptom improvement in 62% of cases. Four patients underwent re-operation. The incidence of clinically significant persistent postoperative dysphagia was 3.6%. Over the same time period, another 11 patients underwent re-operation for persistent dysphagia after antireflux surgery performed elsewhere. Redo surgery was done after a median period of 12 months from the first operation, 77% of re-operated patients obtaining good results. Good results were obtained when an anatomical defect causing dysphagia could be detected. In conclusion, less than 5% of patients submitted to antireflux surgery present persistent postoperative dysphagia. Endoscopic pneumatic dilatation is successful in one-third of the patients. Re-operation gives good results when an anatomical defect causing dysphagia is found. Re-operation for failed fundoplication achieves symptom improvement in a significant percentage of patients (75%).