Mixture Of Saline Research Articles

Capillary electrophoresis for monitoring the effects of plasmapheresis: A feasibility study

Plasmapheresis is an established method to treat patients with large monoclonal gammopathies (M-components) that increases the blood viscosity. During plasmapheresis the patient plasma is substituted with a mixture of saline, albumin and normal plasma. The treatment results in a reduction of the M-component in the circulation. Plasmapheresis causes changes in several proteins, which makes monitoring by nephelometric or turbidimetric analysis of specific proteins less suitable. Quantification of paraproteins by nephelometric assays are also known to be associated with technical problems. An alternative could be agarose gel electrophoresis but this method is too slow to permit monitoring during the plasmapheresis. Capillary electrophoresis of plasma proteins can be performed in less than 10 min. We have used the CAPILLARYS TM capillary electrophoresis system (Sebia, Paris, France) to monitor the effect of plasmapheresis treatment on 22 occasions. The mean reduction in M-component size was 51%, range 33–61%. Capillary electrophoresis is a rapid and inexpensive method that could be used to monitor the effect of plasmapheresis during the actual treatment.

Biodisponibilidade de ferro do açaí (Euterpe oleracea Mart.) e da farinha de mandioca fortificada com ferro em ratos

OBJETIVO: Este estudo teve como objetivo avaliar a biodisponibilidade do ferro do açaí (Euterpe oleracea Mart.) e da farinha de mandioca fortificada com ferro, utilizando o método de depleção e repleção de hemoglobina em ratos. MÉTODOS: No período de depleção, durante a lactação, as ratas (Rattus novergicus) e seus filhotes receberam ração à base de caseína (American Institute of Nutrition - 93G), sem adição de ferro na mistura salina, sendo que os filhotes, quando desmamados, continuaram a receber a mesma ração por mais sete dias. Paralelamente, houve um grupo controle no qual ratas e filhotes receberam ração comercial. No período de repleção de catorze dias, os ratos machos (n=40) foram distribuídos aleatoriamente em cinco grupos de oito ratos cada um, os quais receberam rações experimentais (açaí e farinha de mandioca fortificada com ferro) e controles (do açaí e American Institute of Nutrition 93). A concentração de hemoglobina foi determinada semanalmente e a biodisponibilidade de ferro das rações foi determinada por meio de cálculos do ferro ingerido e do ferro hemoglobínico dos ratos dos diferentes grupos. RESULTADOS: Ao final do período de depleção, a concentração de hemoglobina dos ratos, de 4,7 ± 0,5g/dL, demonstrou a efetividade do método utilizado. A maior biodisponibilidade de ferro foi constatada na farinha de mandioca fortificada (44,6±3,6%), em contraste com a baixa biodisponibilidade do ferro do açaí (12,1±5,5%). CONCLUSÃO: O ferro presente no açaí não foi eficaz na recuperação da concentração de hemoglobina dos ratos. Portanto sugere-se cautela ao recomendar a utilização do açaí como fonte de ferro.

Platelet‐Rich Plasma Combined With a Porous Hydroxyapatite Graft for the Treatment of Intrabony Periodontal Defects in Humans: A Comparative Controlled Clinical Study

The aim of the present controlled clinical study was to compare platelet-rich plasma (PRP) combined with a biodegradable ceramic, porous hydroxyapatite (HA) with a mixture of HA and saline in the treatment of human intrabony defects. Seventy interproximal intrabony osseous defects in 70 healthy, non-smoking subjects diagnosed with chronic periodontitis were included in this study. Thirty-five subjects each were randomly assigned to either the test group (PRP and HA) or control group (HA with saline). Clinical and radiographic measurements were determined at baseline and the 12-month evaluation. When compared to baseline, the 12-month results indicated that, while both treatment modalities resulted in significant changes in all clinical parameters (gingival index, bleeding on probing, probing depth, clinical attachment level, and intrabony defect fill; P <0.001), the test group exhibited statistically significant changes compared to the control sites in probing depth reduction: 4.7 +/- 1.6 mm versus 3.7 +/- 2.0 mm (P <0.05); clinical attachment gain: 3.4 +/- 1.7 mm versus 2.0 +/- 1.2 mm (P <0.001); and vertical relative attachment gain: 70.3% +/- 23.4% versus 45.5% +/- 29.4% (P <0.001). Treatment with a combination of PRP and HA compared to HA with saline led to a significantly more favorable clinical improvement in intrabony periodontal defects.

The Debye-Hückel approximation: Its use in describing electroosmotic flow in micro- and nanochannels

In this work we consider the electroosmotic flow in a rectangular channel. We consider a mixture of water or other neutral solvent and a salt compound, such as sodium chloride, and other buffers for which the ionic species are entirely dissociated. Results are produced for the case where the channel height is much greater than the width of the electric double layer (EDL) (microchannel) and for the case where the channel height is of the order or slightly greater than the width of the EDL (nanochannel). At small cation, anion concentration differences the Debye-Hückel approximation is appropriate; at larger concentration differences, the Gouy-Chapman picture of the electric double emerges naturally. In the symmetric case, the velocity field and the potential are identical. We specifically focus in this paper on the limits of the Debye-Hückel approximation for a simplified version of a phosphate-buffered saline (PBS) mixture. The fluid is assumed to behave as a continuum and the volume flow rate is observed to vary linearly with channel height for electrically driven flow in contrast to pressure-driven flow which varies as height cubed. This means that very large pressure drops are required to drive flows in small channels. However, useful volume flow rates may be obtained at a very low driving voltage. In the course of the solution, we establish the relationship between the wall mole fractions of the electrolytes and the zeta potential. Multivalent electrolyte mixtures are also considered.

Acute effect of an extract of Ambrosia paniculata (Willd.) O. E. Schultz (mugwort) in several models of experimental epilepsy

The acute effect of Ambrosia paniculata was studied in several animal models of epilepsy. Intraperitoneal injections (0.01 mL/g body wt) of a decoction of the dry leaves significantly enhanced the latency to the first convulsion and survival time in mice injected with picrotoxin (7 mg/kg) or isoniazid (210 mg/kg). Epileptic spikes were induced by topical application of penicillin through a glass electrode filled with a penicillin–agar–saline mixture and recorded in sensorimotor and occipital cortices, in rats immobilized with d-tubocurarine. The plant decoction reduced significantly the spike amplitude in both sites. The mentioned effects were elicited at doses that also reduced general motor activity (Irwin test) and exploratory behavior. The decoctions were not effective against electroshock-induced convulsions in mice. The convulsions induced by isoniazid, picrotoxin, and penicillin differed from those induced by electroshock implicating selective disruption of GABAergic neurotransmission. The results suggest that A. paniculata, like several conventional antiepileptic drugs, might act by enhancing GABAergic neurotransmission, a hypothesis that requires further demonstration. These results explain and justify the traditional use of the plant in epilepsy.

Pharmacology Review

Extravasation or inadvertent infiltration of fluids into subcutaneous tissue from peripheral intravenous (IV) devices is a common adverse event in newborns. (1)(2) Although fluids occasionally extravasate from central venous lines, the complication is much more common from peripheral catheters, which are used widely in sick neonates. (3) This article focuses on extravasations from peripheral IV devices. Injury to the skin, even in a very immature neonate, results in an inflammatory response and heals by scar formation. (4) Although the scars from many of these injuries appear to improve with time, (5) tissue necrosis from extravasation injury could result in partial or complete skin loss, infection, and nerve and tendon damage, with the potential risk of permanent cosmetic and functional impairment. (6)(7)(8) The incidence of extravasations from Teflon® catheters has been reported to vary from 23% to 63%. (1) A recent survey of regional neonatal intensive care units in the United Kingdom recorded the prevalence of extravasation injury resulting in skin necrosis as 38 per 1,000 neonates, with 70% of these injuries occurring in infants of 26 weeks’ gestation or less. (2) The incidence of extravasation is related closely to the type of device used, insertion site, duration of therapy, infusate administered, patient activity, and gestational age. (1)(3)(9)(10) The fragility of the skin, particularly in the first 2 weeks after birth, and the lack of subcutaneous tissue in preterm neonates makes them uniquely susceptible to injury and skin loss. Extravasation may occur from the tip of the cannula or needle piercing the vessel wall. Alternatively, distal obstruction of the vein due to thrombosis or venoconstriction from irritation of the vessel wall may lead to increased back pressure and leakage from the entry point of the needle or …

Pulmonary arteriovenous shunting in the normal fetal lung

We hypothesized that pulmonary arteriovenous shunting (PAVS) is normally present in fetal lungs and that cavopulmonary anastomosis-induced PAVS may represent a return to an earlier morphologic stage of development. The surgical superior cavopulmonary anastomosis is performed as part of the staged Fontan pathway to treat univentricular forms of congenital heart disease; PAVS is a known sequela after superior cavopulmonary anastomosis and may have important clinical consequences. Although the etiology and true morphology of the structures responsible for PAVS are unknown, a leading theory is that PAVS is caused by absence of normal hepatic venous drainage to the pulmonary circulation. To determine whether normal fetal lungs demonstrate PAVS, we performed contrast echocardiograms on 13 fetal lambs, 8 neonatal lambs, 4 juvenile lambs, and 4 adult sheep using a blended mixture of saline and blood injected directly into the proximal pulmonary artery. Pulmonary arteriovenous shunting was detected by direct epicardial echocardiography in all fetal lambs (n = 13) and neonatal animals studied at one and three days of life (n = 4) and in two of four animals studied at six to nine days of life. Pulmonary arteriovenous shunting was not present in animals studied at four weeks of life (n = 2) and in adult sheep (n = 5). These studies demonstrate that PAVS is normally present in late gestation fetal and early neonatal lambs but then disappears during the later neonatal period. Furthermore, these findings suggest that PAVS associated with cavopulmonary anastomosis or other processes affecting the developing pulmonary circulation may represent a return to an earlier morphologic stage of development.

MR arthrography of postoperative knee: for which patients is it useful?

To assess which postoperative patients benefit most from MR arthrography of the knee. One hundred consecutive MR arthrograms obtained in patients who had previous knee surgery underwent retrospective review in consensus by three radiologists after prospective reading by one of the three radiologists. Criterion on MR arthrograms for a retear was abnormal tracking of an intraarticular dilute gadolinium-based contrast material and saline mixture into the substance of a meniscus. Patients were separated into three groups: those with more than 25% meniscal resection, those with less than 25% meniscal resection, and those with meniscal repair. All 100 patients had preoperative MR images to review directly in conjunction with the postoperative MR images. Fifty-seven of these 100 patients underwent second-look arthroscopy. Nine patients had MR findings consistent with avascular necrosis. Nineteen patients had marked degenerative arthrosis in the area of previous surgery. Seven patients had chondral defects or injuries. Twenty-nine patients had clear MR evidence of a meniscal retear without any contrast material injected into the joint. In 32 of the 100 patients, intraarticular contrast material was useful in demonstrating a retear. Of these 32 patients, 22 had MR arthrographic evidence of a retear, while 10 had no clear MR arthrographic finding to explain postoperative pain. Four additional patients had no clear MR imaging or MR arthrographic abnormality. All patients with meniscal repair (n = 16) needed MR arthrography to diagnose a residual or recurrent meniscal tear. No patient with less than 25% meniscal resection (n = 23) needed MR arthrography to demonstrate a residual or recurrent meniscal tear. Sixteen of 61 patients with more than 25% meniscal resection needed MR arthrography to demonstrate a residual or recurrent meniscal tear. All patients with meniscal repair required MR arthrography. All patients with meniscal resection of more than 25%, who did not have severe degenerative arthrosis, chondral injuries, or avascular necrosis required MR arthrography. Patients with less than 25% meniscal resection did not need MR arthrography.

Superiority of 10% air–10% blood–saline mixture for measuring the velocity of tricuspid regurgitation in patients with severe emphysema

Background Severe emphysema frequently is associated with elevated pulmonary artery systolic pressure. However, it is often difficult to obtain adequate tricuspid regurgitation (TR) signals for measurement of pulmonary artery systolic pressure in patients with severe emphysema. Purpose This study was conducted to evaluate the usefulness of air-blood-saline mixture in measuring TR velocity in severe emphysema. Methods We studied 82 patients with severe emphysema (67.7 ± 9.2 years, 57 males) who had no or mild TR on color Doppler. Contrast echocardiography studies were performed with agitated 10% air–90% saline and 10% air–10% blood–80% saline mixtures. Tracing quality and peak velocity were assessed on baseline continuous wave signals and contrast continuous wave signals with the 2 mixtures. Results With the injection of an air–saline mixture, the quality of TR tracing improved in 45 patients ( P < .0001) and a higher peak TR velocity was obtained (2.46 ± 0.37 m/s vs 2.95 ± 0.40 m/s, P < .0001) compared with baseline echocardiography. Compared with air–saline mixture, the air–blood–saline mixture further enhanced TR tracing quality in 17 patients ( P < .0001) and the peak TR velocity increased to 3.13 ± 0.42 m/s ( P < .0001). Conclusions In patients with severe emphysema, an air–blood–saline mixture improves the quantifiable TR signals for more accurate estimation of pulmonary artery systolic pressure, even when there is minimal valve TR.

Detection of segmental internal fat by bioelectrical impedance analysis in a biological phantom

Objective Quantification of internal adipose tissue such as visceral adipose tissue currently relies on expensive, cross-sectional imaging modalities. The purpose of this study was to test the hypothesis that surface impedance, determined by bioimpedance analysis, might be used to predict regional internal fat content change in a phantom model. Methods Fresh hollowed-out cucumbers were used as cylindrical biological phantoms to test this hypothesis. After removal of the seeds, the cucumbers were filled with normal saline, mixture of saline and corn oil, or porcine adipose tissue bathed in saline. Surface resistance and reactance were measured with a bioimpedance analyzer accurate to 0.1 Ω (Quantum 10X, RJL Systems), and impedance was calculated. A linear regression model was used to interpret the association between composition and impedance. Results Surface impedance varied linearly with changes in the relative internal corn oil portions ( r– = 0.98). A similar relation was noted with porcine adipose tissue bathed in saline ( r 2 = 0.95) regardless of the specific position of adipose tissue within the cucumber. Conclusion Surface impedance measured by bioimpedance analysis can detect variations in fat content in the interior of a cylindrical phantom.

A homogeneous assay of kinase activity that detects phosphopeptide using fluorescence polarization and zinc

Homogeneous antibody-free assays of protein kinase activity have great utility in high-throughput screening in support of drug discovery. In an effort to develop such an assay, we have used a pair of fluorescein-labeled peptides of identical amino acid sequence with and without phosphorylation on serine to mimic the substrate and product, respectively, of a kinase. Using fluorescence polarization (FP), we have demonstrated that a mixture of zinc sulfate, phosphate-buffered saline, and bovine serum albumin added to the peptides dramatically and differentially increased the fluorescence polarization of the phosphorylated peptide over its nonphosphorylated derivative. A similar FP differential was observed using different peptide pairs, though the magnitude varied. The FP values obtained using this method were directly proportional to the fraction of phosphopeptide present. Therefore, an FP assay was developed using a proprietary kinase. Using this FP method, linear reaction kinetics were obtained in enzyme titration and reaction time course experiments. The IC 50 values for a panel of inhibitors of kinase activity were determined using this FP method and a scintillation proximity assay. The IC 50 values were comparable between the two methods, suggesting that the zinc FP assay may be useful as an inexpensive high-throughput assay for identifying inhibitors of kinase activity.

Xylazine does not induce retrograde flow of spermatozoa into the urinary bladder of sexually rested boars.

The effect of xylazine on the retrograde flow of spermatozoa from their storage sites in the epididymides and vasa deferentia into the urinary bladder of sexually rested boars was examined. The bladder of four boars was evacuated through a surgically implanted urinary catheter and the urine was examined for the presence of spermatozoa. Boars were then given an injection of 2.2 mg of xylazine per kilogram of body weight and, immediately thereafter, 500 ml of saline was infused into the urinary bladder. Approximately 50 ml of the post-treatment mixture of urine and saline, referred to as 'urine', was collected through the catheter at 5, 10, 15, 20, 30 and 45 min after the injection of xylazine, and examined immediately for the presence and motility of spermatozoa. At 60 min, the urinary bladder was evacuated and the remaining 'urine' was examined for the presence and motility of spermatozoa. None of the pre-xylazine urine and post-xylazine fractions of 'urine' had motile spermatozoa and xylazine did not increase (P > 0.1) the concentration and the number of spermatozoa in the post-treatment 'urine'. Thus, in contrast to other species, xylazine does not induce retrograde flow of spermatozoa into the urinary bladder of boars.

Percutaneous MR-guided discography in a low-field system using optical instrument tracking: a feasibility study.

To evaluate the feasibility of MRI-guided discography with optical tracking. 12 consecutive patients who had a clinical suspicion of lumbar discogenic pain and/or suggestive finding of disc degeneration in imaging studies (MRI, CT, plain radiography) underwent MRI-guided discography in order to determine possible pain provocation during puncture and contrast injection. An 0.23 T open configuration MRI device with interventional tools (Outlook Proview, Philips Medical Systems, MR Technologies, Finland) was used in procedural imaging and instrument guidance. An optical guidance tool was attached to the MRI compatible needle (Chiba-type MReye, Cook, Bloomington, IN). After initial disc puncture, 1-2 mL of gadolinium contrast (Magnevist, 469 mg/mL, Schering AG, Germany) saline mixture (1:8) was injected into the disc. Immediately after injection, sagittal FE T1 weighted images were obtained to verify the final position of the needle and formation of the MRI discogram. On nine patients, additional noncontrast sagittal fast spin echo (FSE) T1, FSE T2, and axial 3D T1 gradient echo imaging was performed before and after contrast media injection to obtain MRI discograms. Overall, 35 disc punctures were initialized and 34 MRI discograms were obtained. In all punctures, a positive or negative pain response was obtained. The average time for performing a procedure for three discs was 1 hour 25 minutes (minimum 45 minutes, maximum 2 hours, 15 minutes), and the average number of imaging sequences used for a puncturing one disc was 12. On one disc, the puncture failed and a discogram was not acquired. There was one complication (disc collapse) reported during follow-up. Our results show that MRI guidance in performing discography is accurate and relatively safe. It is a technically comparable method to CT-guidance or fluoroscopy.

Pathomorphological alterations and degree of reparatory processes in the liver of broilers treated with t-2 toxin

The 42-day long trial was performed on a total of 48 Hybro broilers divided into four groups. After a 14 day pre-experimental period, the experimental groups were treated daily with T-2 toxin at 0.02 mg/kg BW for 7, 14 or 21 days respectively and a mixture of ethanol and physiological saline was administered to the control group of birds. Liver samples were taken after the period of toxin administration and the remaining birds from the control and experimental groups were normally fed and watered without toxin application until the end of the trial when liver samples were taken again. Histogenetic development of dystrophic and dyscyclic changes were found in the livers of the treated broilers. Morphological alterations of the liver were diverse in character, intensity and spread depending on the duration of exposure of broilers to the adverse effects of T-2 toxin, as well as the total quantity of toxin applied. The degree of the reparation varied depending on the duration of exposure to toxin, as well as the resting period. Evident reversible processes were found after short term exposure followed by a long resting period, while regeneration processes were not pronounced after chronic poisoning followed by a short resting period.

A randomized, placebo controlled, trial of preoperative sustained release Betamethasone plus non-controlled intraoperative Ketorolac or Fentanyl on pain after diagnostic laparoscopy or laparoscopic tubal ligation [ISRCTN52633712

BackgroundGynecological laparoscopic surgery procedures are often complicated by postoperative pain resulting in an unpleasant experience for the patient, delayed discharge, and increased cost. Glucocorticosteroids have been suggested to reduce the severity and incidence of postoperative pain.MethodsThis study examines the efficacy of a sustained release betamethasone preparation to reduce postoperative pain and the requirement for pain relief drugs after either diagnostic laparoscopy or tubal ligation. Patients were recruited, as presenting, after obtaining informed consent. Prior to surgery, patients were randomly selected by a computer generated table to receive either pharmacy-coded betamethasone (12 mg IM Celestone™) or an optically identical placebo injection of Intralipid™ and isotonic saline mixture. The effect of non-controlled prophylactic intraoperative treatment with either fentanyl or ketorolac per surgeon's orders was also noted in this study. Blood samples taken at recovery and at discharge times were extracted and analyzed for circulating betamethasone. Visual analog scale data on pain was gathered at six post-recovery time points in a triple blind fashion and statistically compared. The postoperative requirement for pain relief drugs was also examined.ResultsAlthough the injection achieved a sustained therapeutic concentration, no beneficial effect of IM betamethasone on postoperative pain or reduction in pain relief drugs was observed during the postoperative period. Indeed, the mean combined pain scores during the 2 hour postoperative period, adjusted for postoperative opioids as the major confounding factor, were higher approaching statistical significance (P = 0.056) in the treatment group. Higher pain scores were also observed for the tubal ligation patients relative to diagnostic laparoscopy. Intraoperative fentanyl treatment did not significantly lower the average pain score during the 2 hour postoperative period. Intraoperative ketorolac treatment significantly lowered (P = 0.027) pain scores and reduced the postoperative requirement for additional pain relief drugs.ConclusionsThere was a lack of efficacy of preoperative sustained release betamethasone in reducing postoperative pain despite maintaining a therapeutic concentration during the postoperative period. Intraoperative Ketorolac did afford some short-term pain relief in the postoperative period and reduced the need for additional pain relief drugs.

Hydrogen Peroxide Irrigation: Avoid It or Be Prepared for It?

Hydrogen Peroxide Irrigation: Avoid It or Be Prepared for It? In Response: We appreciate the interesting comments of Dubey about our article (1). Certainly, we fully agree that our case was a direct left-sided oxygen embolism and the cardiac arrest must have been produced by a right coronary oxygen embolism. In our hospital, cardiac surgeons usually use a mixture of saline and povidone-iodine as wound irrigation solution. Surgeon used the H2O2, in our case, in order to remove the great amount of clots and improve the field visualization and facilitate the localization of bleeding site. This is a common practice in neurosurgery and in endoscopic procedures (2). Hydrogen peroxide is an agent with a weak germicidal effect, and its use do not offer any advantage with respect to other antiseptics (3). This fact, and the wide literature reported about the hazards of hydrogen peroxide irrigation should advise against their freely use in surgery. We think that, perhaps, the most suitable answer to the question that you raise should be: the best preparation to reduce the hydrogen peroxide hazards is to avoid it. José A. Sastre Rincón, MBBS María A. Prieto Rodrigo, MBBS José C. Garzón Sánchez, MBBS Clemente Muriel Villoria, MD, Professor

Local delivery of basic fibroblast growth factor increases both angiogenesis and engraftment of hepatocytes in tissue-engineered polymer devices.

We investigated heterotopic hepatocyte transplantation on biodegradable polymers as a potential treatment for end-stage liver disease. The primary problem has been insufficient engraftment of transplanted cells partly because of insufficient vascularization. Increasing vascularization through locally delivered angiogenic factors may increase angiogenesis and hepatocyte engraftment. We studied the effect of local delivery of basic fibroblast growth factor (bFGF) on angiogenesis and hepatocyte engraftment within tissue-engineered liver constructs. Poly-l-lactic acid discs were fabricated and coated with either a mixture of saline, sucralfate, and Hydron (control group) or bFGF, sucralfate, and Hydron (bFGF group). bFGF release from polymers in vitro was tested using an ELISA. Hepatocytes were isolated from Lewis rats, seeded on control (n=9) or bFGF (n=11) polymers, and implanted into the small bowel mesentery of syngeneic animals. Specimens were harvested after 2 weeks and analyzed for hepatocyte engraftment. Microvascular density was compared between control (n=6) and bFGF groups (n=5). Three hundred twenty-three thousandths of a microgram of bFGF were incorporated per polymer. Greater than 99% of the bFGF was released into solution by 72 hr in vitro. Two weeks after implantation, microvascular density, as measured by capillaries per high-powered field (c/hpf), was significantly greater in the bFGF group (43.8 c/hpf), compared with the control group (30.5 c/hpf; P<0.005). Specimens from the bFGF group (mean engraftment, 61,355 microm2) showed a 2.5-fold increase in hepatocyte engraftment as compared with control (24,197 microm2; P<0.002). The angiogenic growth factor bFGF can be incorporated into degradable polymers used as delivery devices for hepatocyte transplantation. Implantation of these devices increases angiogenesis into the device and increases hepatocyte engraftment.

The usefulness of a 10% air-10% blood-80% saline mixture for contrast echocardiography: Doppler measurement of pulmonary artery systolic pressure

ObjectivesWe assessed an air-blood-saline mixture for Doppler measurement of pulmonary artery systolic pressure (PASP) and the mechanism of enhancement of the Doppler signal by this mixture. BackgroundUnderestimation of PASP by Doppler echocardiography occurs with inadequate continuous wave (CW) signals of tricuspid regurgitation (TR). MethodsWe assessed in vitro the diameter and concentration of microbubbles of agitated air-saline mixture, air-blood-saline mixture and 10% air-10% plasma-80% saline mixture immediately, 5, 10 and 20 s after agitation. In 20 patients, PASP was estimated by Swan-Ganz catheter and CW Doppler of TR: 1) without contrast injection; 2) with intravenous injection of 10% air-90% saline; and 3) 10% blood-10% air-80% saline mixture. ResultsCompared to air-saline, addition of blood or plasma to the air-saline solution significantly increased the concentration of microbubbles (p < 0.001). The air-blood-saline (26.7 ± 7.2 μ) and air-plasma-saline mixture (25.3 ± 7.4 μ) had smaller microbubbles than air-saline mixture (31.6 ± 8.2 μ) (p < 0.001). The correlation between Doppler- and catheter-measured PASP at baseline (r = 0.64) improved with agitated air-saline (r = 0.86). With the air-blood-saline mixture, the correlation further improved (r = 0.92) and the best limits of agreement were obtained. ConclusionsThe combination of the patient’s own blood is a method of making a sterile solution of numerous small microbubbles for injection into the right-sided cardiac chambers. Clinically, the air-blood-saline mixture is easily prepared at bedside and is superior to the air-saline mixture in assessing PASP in patients with inadequate CW Doppler signals.

The feasibility and safety of fluoroscopy-guided percutaneous intramyocardial gene injection in porcine heart

Background: Catheter-based transendocardial gene injection would be useful for the delivery of genes into the heart. We examined the feasibility and safety of percutaneous intramyocardial gene injections with fluoroscopic guidance alone. Methods: We performed the procedure through an 8F arterial sheath inserted into the left carotid artery. In protocol 1, a mixture of India ink and normal saline was injected through a needle injection catheter in six pigs. We monitored blood pressure and ECG continuously during the procedure. Echocardiography, left ventriculography, and coronary angiography were performed. All pigs were sacrificed 2 days later and hearts were harvested. In protocol 2, a mixture of India ink and plasmid encoding CAT gene was injected in the same manner in eight pigs. Myocardial tissue was obtained 7 days after the procedure to assess gene expression. In protocol 3, four pigs were intentionally needle-perforated in the ventricular wall and were observed for 7 days. Results: In protocol 1, there was no significant hemodynamic changes or serious arrhythmias during the procedure. Echocardiography and angiography revealed no evidence indicating pericardial effusion or wall motion abnormalities. Harvested hearts revealed one intramyocardial hematoma in a total of 36 injection sites. In protocol 2, the gene expression could be identified in 39 sites out of 48 injections after 7 days. In protocol 3, no animal showed signs indicating cardiac tamponade during the observation period. Conclusions: Our data suggest that fluoroscopy-guided percutaneous intramyocardial gene injection is a feasible and safe procedure, with no indication of associated significant hemodynamic changes, arrhythmias, or mortality.

Viral croup.

Viral croup.