Use Of Hypertonic Solutions Research Articles

Factors Related to Phlebitis in Internal, Surgical and Child Hospital Treatment Rooms

Phlebitis is an inflammation of the veins that occurs as a result of unsuccessful vein puncture, contamination of IV equipment and inadequate use of hypertonic solutions which can chemically irritate the veins. To minimize the risk of infection, nurses need to be aware of and recognize which factors are dominant in the incidence of phlebitis. This study aims to determine the incidence of phlebitis in the internal, surgical and pediatric ward of the hospital. The research design used was an analytic survey with a prospective (Study Cohort) approach, which is an observational study, meaning that the risk factors to be studied are identified first. It is then followed up prospectively. Sampling was carried out by purposive sampling method with a total sample of 57 people, then the results were tested using a computer program with the Chi Square test with a significance level of α = 0.05. The results of this study showed that there was no relationship between age and the incidence of phlebitis (p value = 0.531 > 0.05), there was a relationship between gender and the incidence of phlebitis (p value = 0.007 <0.005), there was a relationship between the size of intravenous catheter cannula and the incidence of phlebitis (p value = 0.001 < 0.05), there was no relationship between the type of fluid and the incidence of phlebitis (p value 0.373 > 0.05), there was a relationship between the type of infusion set and the incidence of phlebitis (p value 0.016 < 0.05), and There is a relationship between the infusion procedure and the incidence of phlebitis (p value 0.004 <0.05). The conclusion is that there is a relationship between gender, type of infusion set, size of intravenous catheter cannula, infusion procedure and no relationship between age and type of fluid with the incidence of phlebitis.

Removal of Brain Hydatid Cyst through Burr-Hole Operation (Case Report)

Brain involvement occurs in 2–3% of patients with systemic echinococcosis. Children are most often affected and, in countries where echinococcosis is common, up to 50% of all childhood CNS “tumors” prove to be echinococcal cysts, life saving rapid burr hole aspiration of cyst with total removal of cyst membrane with the use of hypertonic solution as cidal agent with pre and post operative antiprotozoal is very successful procedure in emergency deteriorating patient with brain hydatid.

Intraocular pressure changes in the intensive care unit: The effect of spontaneous respiration, mechanical ventilation, non-invasive cpap and medical treatments

Aim: The aim of this study was to investigate the intraocular pressure (IOP) changes in patients in intensive care unit (ICU) and the parameters that cause these changes.Material and Methods: In total, 304 eyes of 152 patients were examined. IOP and central corneal thickness (CCT) were measured. Age, sex, hospitalization (surgical/non-surgical causes), type of ventilation (spontaneous, intubated, non-invasive continuous positive airway pressure (CPAP), Glasgow coma scale, use of hypertonic solution and sedation status were evaluated.Results: The mean age was 63.52±21.47 (range: 18–96) years, and the male/female ratio was 73/79. The mean hospitalization time was 30.91±47.80 (8-297) days, and the mean Glasgow coma scale score was 9.61±4.42. While 33 patients (21.7%) had hypertonic solution, 28 (18.4%) were sedated. The mean IOP was measured as 13.81±3.58 (6–28) mmHg. In 5 patients, the IOP was more than 20 mmHg, and in 14 patients, it was less than 10 mmHg. It was observed that gender and hospitalization diagnosis had no effect on the IOP change (p=0.97, p=0.814, respectively). When the patients were evaluated according to their respiration types, there was no statistically significant difference in IOP values between patients with spontaneous respiration and intubated patients (p=0.261), but non-invasive CPAP patients were significantly different from patients with spontaneous breathing (p=0.035) and intubated patients (p0.001). In addition, the use of hypertonic solution and sedation significantly decreased IOP (p0.001 in both groups).Conclusion: Some changes in IOP were observed due to some applications in the ICU. These changes are often not significant in patients with no eye problems. However, patients with a glaucoma diagnosis or susceptibility to glaucoma, as well as patients with simultaneous IOP reduction, should be carefully monitored for IOP changes.

Antibacterial effects of ER: YAG-PIPS, ER, CR: YSGG laser and conventional irrigation on enterococcus faecalis and candida albicans

Aim: The aim of this study was to investigate the intraocular pressure (IOP) changes in patients in intensive care unit (ICU) and the parameters that cause these changes.Material and Methods: In total, 304 eyes of 152 patients were examined. IOP and central corneal thickness (CCT) were measured. Age, sex, hospitalization (surgical/non-surgical causes), type of ventilation (spontaneous, intubated, non-invasive continuous positive airway pressure (CPAP), Glasgow coma scale, use of hypertonic solution and sedation status were evaluated.Results: The mean age was 63.52±21.47 (range: 18–96) years, and the male/female ratio was 73/79. The mean hospitalization time was 30.91±47.80 (8-297) days, and the mean Glasgow coma scale score was 9.61±4.42. While 33 patients (21.7%) had hypertonic solution, 28 (18.4%) were sedated. The mean IOP was measured as 13.81±3.58 (6–28) mmHg. In 5 patients, the IOP was more than 20 mmHg, and in 14 patients, it was less than 10 mmHg. It was observed that gender and hospitalization diagnosis had no effect on the IOP change (p=0.97, p=0.814, respectively). When the patients were evaluated according to their respiration types, there was no statistically significant difference in IOP values between patients with spontaneous respiration and intubated patients (p=0.261), but non-invasive CPAP patients were significantly different from patients with spontaneous breathing (p=0.035) and intubated patients (p0.001). In addition, the use of hypertonic solution and sedation significantly decreased IOP (p0.001 in both groups).Conclusion: Some changes in IOP were observed due to some applications in the ICU. These changes are often not significant in patients with no eye problems. However, patients with a glaucoma diagnosis or susceptibility to glaucoma, as well as patients with simultaneous IOP reduction, should be carefully monitored for IOP changes.

Chemical and Microbiological Changes in Blueberries and in Hypertonic Solution during Osmotic Dehydration Employing Reused Concentrate

AbstractDehydration was carried out in 65°Brix sucrose solution at 40C for 120 min. The solution was used 15 times, each time a new batch of fruits was processed. Prior to dehydration, the fruits were subjected to pretreatment by immersion in solutions containing pectinolytic and lipolytic enzymes. Following dehydration, the dehydrated material and osmotic solution were tested for the content of dry matter (36.6 ± 3.3% [w/w] and 58–61°Brix, respectively), total polyphenols (1,738 ± 289 mg/100 g initial dry matter [IDM]), anthocyanins (606 ± 58 mg/100 g IDM) and flavan‐3‐ols (695 ± 139 mg/100 g IDM). The highest retention of anthocyanins was observed for cyanidin‐3‐O‐glucoside (over 81%), petunidin‐3‐O‐glucoside, malvidin‐3‐O‐arabinoside and malvidin‐3‐O‐glucoside (over 74%). The average retention of procyanidins in fruits was 77%. The pH value of the hypertonic solution remained at the level of 3.4–3.7. The syrup used for osmotic dehydration was characterized by a relatively low quantity of mesophilic bacteria (<103 cfu/mL) but a higher contamination with osmotolerant yeasts and molds (from 1 × 103 to 2.5 × 104 cfu/mL).Practical ApplicationsThe article deals with osmotic dehydration, which is a method that allows a partial removal of water from plant material. Using this method, one can obtain high‐quality products because the water removal is conducted without phase change. However, considerable amounts of hypertonic solution (used for osmotic dehydration) pose a problem. Management of spent syrup is one of the most important problems related to osmotic dewatering. Thus, repeated use of hypertonic solution is indispensable; however, it may have an influence on the product quality. The paper presents the chemical and microbiological changes that occur during osmotic dehydration of highbush blueberry fruits over 15 cycles employing reused sucrose solution. Prior to dehydration, the fruits were subjected to pretreatment by immersion in solutions containing pectinolytic and (which is a new approach to pretreatment before osmotic dehydration) lipolytic enzymes. The results indicate that applied procedure enables to obtain osmodehydrated berries without a large decrease in the product quality.

Uso de soluções hipertônicas para preservação hepática em ratos

The success of a transplant depends mainly on the viability of the graft, which is currently the main point of difficulty focuses on the triad preservation-rejection-infection. There are several specific components of preservation solutions that could prevent certain tissue damage. From these components, the osmotic factor has been highlighted as a factor in preventing edema and subsequent cell death, suggesting a possible advantage in the use of hypertonic solutions for organ preservation. To compare different hypertonic solutions as alternative to liver preservation. A total of 105 Wistar rats were divided in Standard Group (GP, n=5 rats), to verify the normal range of the study, and five experimental groups of 20 rats each, according to the preservation solution used: Group Eurocollins (GE), Group Saline 0.9% (GF), Group Glucose 50% (GG), Group Mannitol 20% (GM), Group Salty - NaCl 7.5% (GS). All animals in experimental group were also divided into four subgroups according to the time of collection in: 0 h, 2 h, 6 h and 12 h. Was assessed cell viability by the reaction with Methyl Blue Thiazolyl (MTT) and the dosages of lactate and alanine aminotransferase (ALT). Regarding the lactate level, was observed a relative improvement of hypertonic solutions compared to eurocollins, and in 12 h, the GE and GS showed no statistically significant difference (p> 0.05). When assessed cell viability, absorbance at MTT also demonstrated favorable results to the GS, since no statistically significant difference in relation to GE. The 7.5% NaCl solution showed promising results for organ preservation, presenting parameters and capability comparable to eurocollins preservation solution.

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Effect of hypertonic saline on apoptosis of polymorphonuclear cells

BackgroundThe function of polymorphonuclear (PMN) cells can be influenced by the choice of resuscitation fluids in hemorrhagic shock. Widespread interest in the use of hypertonic solutions for resuscitation has led to extensive investigation of their immune-modulating properties. Hypertonic saline (HTS) is known to modulate immune reactions, preventing the multiorgan failure mediated by immune reactions in trauma and hemorrhagic shock. PMN cells play a key role in such immune-mediated inflammatory processes, and HTS is believed to affect these PMN cells. However, how these events influence the actual event of apoptosis has not yet been described. Thus, in the present study, we aimed to investigate the differences in the apoptosis of PMN cells when exposed to isotonic and hypertonic environments and the temporal relations between the interval of administration of HTS after the stimulation of PMN cells. MethodsWhole blood was sampled from healthy volunteers, and the PMN cells were isolated. The isolated layer of PMN cells was washed twice with phosphate-buffered saline to yield the PMN cells. The number of cells was kept uniform, and an overall survival rate greater than 95% was maintained. After stimulation of the isolated PMN cells with N-formyl-methionyl-leucyl-phenylalanine, the PMN cells were allocated into 3 study groups (i.e., 1 isotonic group and 2 hypertonic groups with an osmolarity of 160 mM and 180 mM each). The extent of apoptosis was investigated in each group after culturing the PMN cells for 0, 1, 3, 6, 12, 15, 18, and 24 h. Depending on whether the PMN cells were stimulated with N-formyl-methionyl-leucyl-phenylalanine, they were also divided into stimulated and nonstimulated groups. In the stimulated group, the hypertonic environment was fostered immediately (HTS 0 h) and 6 h (HTS 6 h) after stimulation, which was accomplished after allocating the cells into an isotonic group (140 mM) and a hypertonic group (180 mM), according to the concentration of the culture medium. The PMN cells were then cultured at 37°C for 15 h with 5% carbon dioxide incubation. Each PMN suspension was labeled with Annexin V-fluorescein isothiocyanate and propidium iodide. Each sample underwent immediate flow cytometric analysis. PMN cells with high propidium iodide uptake were considered nonviable (necrotic). Among the viable PMN cells, those with no Annexin V uptake were considered normal and those with Annexin V uptake were considered apoptotic. ResultsDecreased apoptosis was observed in the PMN cells stimulated with N-formyl-methionyl-leucyl-phenylalanine. Increased apoptosis was observed in the stimulated PMN cells incubated in hypertonic condition compared with the cells incubated in isotonic condition. Early HTS administration demonstrated increased apoptosis compared with late administration. ConclusionsHTS treatment resulted in increased PMN apoptosis and an anti-inflammatory effect. Decreased apoptosis (prolonged lifespan) has been implicated in neutrophil-mediated tissue damage. HTS, by increasing the apoptosis of PMN cells, attenuates the postinjury inflammatory response. Also, early treatment with HTS was more efficient than delayed treatment.

Optimization of osmotic shock process variables for enhancement of the release of periplasmic interferon-α2b from Escherichia coli using response surface method

The osmotic shock process for the release of periplasmic recombinant human interferon-α2b from Escherichia coli was optimized using response surface method (RSM). The process parameters such as pH, buffer concentration and sucrose concentration in hypertonic solution, cell concentration to hypertonic solution, contact time of cells with hypertonic solution, temperature of hypertonic solution, cell concentration to hypotonic solution, contact time of cells with hypotonic solution and temperature of hypotonic solution were initially screened using Plackett Burman design. Further optimization was carried out using central composite design (one of the design in RSM) for sucrose concentration in hypertonic solution as well as cell concentration to hypertonic and hypotonic solutions. The optimal cell concentration was 0.05 g/mL in hypertonic solution and 0.2 g/mL in hypotonic solution. The use of hypertonic solution containing 18% sucrose with a combination of 100 mM Tris and 2.5 mM EDTA buffer (pH 8.0 and 25 °C) and cold water (4 °C) as a hypotonic solution gave the optimum release of interferon-α2b. Increased product concentration in the final solution resulted from the optimized process would reduce the downstream steps during purification. The concept of reuse of hypertonic solution was also demonstrated.

Use of hypertonic solutions of sodium chloride in hypergranulating wounds

Use of hypertonic solutions of sodium chloride in hypergranulating wounds

Utilização da solução hipertônica de cloreto de sódio em ferida hipergranulada

ABSTRACTObjective: to verify the efficiency of hypertonic solution (NaCl/20%) on the hypergranulation due to the constant hypergranulating wound beds treated in venous ulcers in the daily clinic practice, which delays and disables cells epithelization. Methodology: clinical case study, performed in an outpatient’s clinic of Médio Vale do Paraíba, from February to March 2008. MCT, 60 years old, female, white skin, systematic arterial hypertension controlled, with wounds on the middle part and region of distal third of the left leg. Dressings were made with prior sterilization sores of sodium chloride to 0.9%, which was applied compress of gauze soaked with hypertonic solution (NaCl 20%) was applied on the region presenting hypergrantulation tissue and immediately occluded with dry gauze and fixed with crepe bandage and adhesive tapes. Results: on February 13, 2008, the first wound on the middle part of the left leg measured 3,5 x 2,3 inches (9x6 cm) and 2,7 9 inches (7 cm) of hypergranulation, and the second wound on the region of distal third of the left leg measured 5,5 x 5,1 inches (14x13 cm) and 5,1 inches (13 cm) of hypergranulation. After 22 days, the first wound measured 1,5 x 1,5 inches (4X4 cm) and 1,5 inches (4 cm) of hypergranulation and the second wound measured 4,3 x 3,9 inches (11X10 cm) and 2,3 inches (6 cm) of hypergranulation. Conclusion: the healing process presented a satisfactory evolution after applying hypertonic solution (NaCl/20%) improving the characteristic of the wound bed and diminishing the area where hypergranulation was present. Descriptors: sodium chloride; varicose ulcer; granulation tissue.RESUMOObjetivo: verificar a eficácia da solução hipertônica de Cloreto de Sódio (NaCl/20%) em paciente portador de úlcera venosas que apresentam hipergranulação no leito da ferida. Metodologia: estudo de caso clínico, realizado no ambulatório do Médio Vale do Paraíba, no período de fevereiro a março de 2008. MCT, 60 anos, sexo feminino, cor branca, hipertensão arterial sistêmica controlada, com feridas na região dos terços médio e distal da perna esquerda. Foram realizados curativos, com prévia assepsia da úlcera com cloreto de sódio a 0,9%, na qual era aplicada compressa de gaze impregnada com solução hipertônica (NaCl 20%) sobre a região que apresentava o tecido de hipergranulação, em seguida ocluída com compressa de gaze seca e fixado com atadura de crepe e fita adesiva. Resultados: em 13/02/2008 a ferida 1 na região do terço médio da perna esquerda mensurava 9x6 cm e 7 cm de hipergranulação, e a ferida 2 na região do terço distal da perna esquerda mensurava 14x13 cm e 13 cm de hipergranulação. Após 22 dias a ferida 1 media 4X4 cm e 4 cm de hipergranulação e a ferida 2 mensurava 11X10 cm e 6 cm de hipergranulação. Conclusão: o processo de cicatrização apresentou uma evolução satisfatória após a aplicação da solução hipertônica (NaCl/20%) melhorando a característica do leito da ferida e diminuindo a área em que apresentava hipergranulação. Descritores: cloreto de sódio; úlcera venosa; tecido de granulação.RESUMENObjetivo: confirmar la eficiencia de la solución hipertónica (NaCl/20%) el paciente portador de úlcera venosa que presentaba tejido de hipergranulación en el lecho de la herida. Metodologia: estudio del caso clínico realizado en el ambulatorio de una ciudad del Medio Vale do Paraíba durante el período de febrero a marzo de 2008. MCT, 60 años, sexo femenino, color blanca, hipertensión arterial sistémica controlada, con heridas en la región del tercio medio y la región del tercio distal de la pierna izquierda. Apósitos se hicieron antes de la esterilización con las llagas de cloruro de sodio al 0,9%, lo que se aplicó la compresa de gasa empapada con solución hipertónica (NaCl/20%) sobre la región que presenta el tejido de hipergranulación, en seguida ocluída con una compresa de gasa seca y asegurada con atadura de crepe y cinta adhesiva. Resultados: el 13/02/2008 la primera herida en la región del tercio medio de la pierna izquierda medía 9x6 cm y 7 cm de hipergranulación y la segunda herida en la región del tercio distal de la pierna izquierda medía 14x13 cm y 13 cm de hipergranulación. Después de 22 días, la primera herida medía 4X4 cm y 4cm=0cm de hipergranulación y la segunda herida medía 11X10cm y 6 cm de hipergranulación. Conclusión: el proceso de cicatrización presentó una evolución satisfactoria después de la aplicación de la solución hipertónica (NaCl/20%) mejorando la característica del lecho de la herida y disminuyendo el área que presentaba hipergranulación. Descriptores: cloruro de sódio; úlcera varicosa; tejido de granulación.

Operating Room Use of Hypertonic Solutions: A Clinical Review

Hyperosmotic-hyperoncotic solutions have been widely used during prehospital care of trauma patients and have shown positive hemodynamic effects. Recently, there has been a growing interest in intra-operative use of hypertonic solutions. We reviewed 30 clinical studies on the use of hypertonic saline solutions during surgeries, with the majority being cardiac surgeries. Reduced positive fluid balance, increased cardiac index, and decreased systemic vascular resistance were the main beneficial effects of using hypertonic solutions in this population. Well-designed clinical trials are highly needed, particularly in aortic aneurysm repair surgeries, where hypertonic solutions have shown many beneficial effects. Examining the immunomodulatory effects of hypertonic solutions should also be a priority in future studies.

Bernard Katz, quantal transmitter release and the foundations of presynaptic physiology

Bernard Katz, quantal transmitter release and the foundations of presynaptic physiology

Transfusion vs. alternative treatment modalities in acute bleeding: a systematic review

The practice of transfusion varies a great deal between countries and hospitals. Therefore, a systematic literature review was performed to evaluate the evidence underlying practice of transfusion and alternative treatment modalities in acute bleeding. After a stepwise evaluation, 79 out of 2438 abstracts were approved as the evidence base. Albumin for volume therapy is not better than artificial colloids or crystalloids and may be detrimental in trauma patients. No outcome difference has been proved between artificial colloids and crystalloids. Use of hypertonic solutions remains controversial, as do the concepts of delayed and hypotensive resuscitation. Healthy individuals tolerate acute, normovolaemic anaemia at 5 g haemoglobin/dl, but pre-operative haemoglobin < 6 g/dl gives increased mortality from surgical interventions. Keeping haemoglobin higher than 8-9 g/dl has not been associated with any positive effect on mortality or morbidity, even in patients with cardiovascular disease. The changes induced in erythrocytes by storage may be clinically insignificant. No alternative to erythrocyte transfusion was established. Evidence underlying the practice of thrombocyte and plasma transfusion is scarce. Available evidence on recombinant coagulation factor VIIa is insufficient to define its future role in acute bleedings. Antifibrinolytic drugs in general seem to reduce the need for transfusion. Intravenous volume replacement and transfusion policies seem largely based on local tradition and expert opinions. As a result of the difficulties in performing controlled studies in patients with acute bleeding and the large number of patients needed to prove effects, other scientific evidence should be sought to better define best practice in this important field.

Mechanisms of Action of Hypertonic Saline Resuscitation in Severe Sepsis and Septic Shock

Small volumes of 7.5% NaCl (2400mOsm/L) have been extensive evaluated in animal models of hemorrhagic shock and in clinical trials of post-traumatic hypotension and as volume support for complex cardiovascular procedures. Hypertonic solutions promote immediate blood volume expansion, restore cardiac output and regional blood flows, improve microcirculation and modulate immune responses, thereby decreasing inflammatory responses triggered by shock and trauma. A large number of very interesting in vivo and in vitro experiments highlighted that hypertonic saline resuscitation may decrease susceptibility to post-traumatic sepsis, modulate trauma and sepsis-induced immune dysfunction, inflammatory response and apoptosis. All those long-term benefits associated with hypertonic resuscitation may be of potential relevance for the management of severe sepsis and septic shock In this review, we describe the mechanisms of action of hypertonic saline based on experimental studies as well as its efficacy and safety based on its clinical use. We believe those studies support the need for additional experimental and clinical studies before the widespread use of hypertonic solutions for the treatment of severe sepsis and septic shock.

Negotiated Care Improves Fluid Status in Diabetic Peritoneal Dialysis Patients

Volume overload is common in diabetic patients on continuous ambulatory peritoneal dialysis (PD), especially when the patient's residual renal function decreases with time on PD. Due to the higher dietary salt and fluid intake, diabetic PD patients tend to use more hypertonic glucose solution to remove excess fluid, which in turn may lead to increased membrane permeability. In the present study, we investigated the effect of negotiated care on fluid status in diabetic PD patients. All diabetic PD patients who had been on PD for at least 3 months by the end of year 2002 in the First Hospital of Peking University were included in the present study. A primary nurse was assigned to each patient and intensive patient education was implemented, focusing on the importance of dietary salt and fluid restriction, the detrimental effect of using more hypertonic glucose solution, and the consequence of fluid overload. Decisions on dialysis prescriptions were made after extensive discussion among the primary nurse, nephrologists, patients, and patients' families. A patient support group was also involved when it was necessary. All the patients were followed for 1 year and fluid status, compliance to dietary restriction, and dialysis prescription were evaluated before the start and at the end of the study. There were 30 diabetic PD patients (age 65.4 +/- 10.3 years; on PD for 24.5 +/- 19.9 months, range 3 - 66 months) included in the study when it was started. During the 1 year of follow-up, 4 patients died of diabetic complications, 3 patients were transferred to hemodialysis due to resistant peritonitis, and 2 patients were transplanted. By the end of follow-up, 21 patients remained on PD, among whom 15 had improved fluid status, 4 did not change, and 2 had worsened fluid status as assessed by clinical and bio-impedance evaluation. Patient compliance to dietary salt and fluid restriction had increased from 19.5% to 76.2%. During the follow-up, 8 patients were anuric at the beginning of the study and the remaining 22 patients had declining residual renal function. Only 4 patients increased their use of hypertonic solution including 2.5% (3 patients) and 4.25% (1 patient) glucose, whereas 5 patients decreased their use of 2.5% dialysis solution. By the end of follow-up, only 1 of the 21 patients was using 4.25% glucose solution and all the patients had good blood glucose control. Our results suggest that negotiated care can be successfully used in diabetic PD patients. It helps to minimize the use of hypertonic glucose solution and improves patient compliance to dietary restriction of salt and fluid intake, and thus improves their fluid status.

Tissue damage of different submucosal injection solutions for EMR

When choosing submucosal injection solutions for EMR, tissue damage should be considered, as well as the lesion-lifting ability. The objective of the study was to find out the potential tissue damage of submucosal injection solutions. The submucosal injection solutions examined were the following: normal saline solution (NS), 3.75% NaCl, 20% and 50% dextrose water (DW), a glycerin solution (Glyceol; 10% glycerin with 0.9% NaCl plus 5% fructose), and two hyaluronic acid (HA) solutions (0.25% 1900 kDa/NS solution and 0.125% 1900 kDa/ Glyceol solution). Furthermore, DW with different concentrations (5%, 10%, 15%, 30%, 40%) also was examined to find out the tolerable concentration without tissue damage. A total of 2 mL of each solution per stomach were injected by endoscopy into the submucosal layer at the separate sites of 4 living minipigs. Two minipigs were euthanized after 30 minutes of endoscopic observations, and the others were euthanized after additional endoscopic observations a week after injection. There was no apparent tissue damage in NS, 5% and 10% DW, Glyceol, or two solutions of HA, whereas, hypertonic solutions, except Glyceol and 10% DW, have more or less potency of tissue damage. In 3.75% NaCl and DW with concentrations of >or=20%, considerable tissue damage was observed, which might affect resected EMR specimens and ulcer healing. Use of hypertonic solutions except Glyceol is not recommended with respect to tissue damage. A combination of HA and Glyceol is the most favorable submucosal injection solution, considering tissue damage and lesion-lifting ability.

Traumatic Brain Injury and Use of Hypertonic Solutions

SUMMARYHypertonic saline (HS) solutions are increasingly used for reduction of elevated intracranial pressure in head‐injured children and adults. Advantages over other hypertonic solutions such as mannitol were demonstrated in experimental and clinical studies with respect to intracranial pressure reduction, improvement of cerebral perfusion pressure, and cerebral oxygenation. However, there remains considerable uncertainty about the indications for the use of HS, the appropriate administration protocol, and the potential risks of using HS. The rationale of this article is to bring a systematic order into the currently available results and to help develop a protocol for the indication and application of HS solutions in adults and children with severe brain injury. Furthermore, fields of necessary future research are outlined.

Hypertonic versus near isotonic crystalloid for fluid resuscitation in critically ill patients.

Hypertonic solutions are considered to have a greater ability to expand blood volume and thus elevate blood pressure and can be administered as a small volume infusion over a short time period. On the other hand, the use of hypertonic solutions for volume replacement may also have important disadvantages. To determine whether hypertonic crystalloid decreases mortality in patients with hypovolaemia. We searched MEDLINE, EMBASE, The Cochrane Controlled Trials Register and the specialised register of the Cochrane Injuries Group. We checked reference lists of all articles identified and searched the National Research Register. Randomised trials comparing hypertonic to isotonic and near isotonic crystalloid in patients with trauma, burns or undergoing surgery. Two authors independently extracted the data and assessed the quality of the trials. Fourteen trials with a total of 956 participants are included in the meta-analysis. The pooled relative risk (RR) for death in trauma patients was 0.84 (95% confidence interval [CI] 0.69-1.04); in patients with burns 1.49 (95% CI 0.56-3.95); and in patients undergoing surgery 0.51 (95% CI 0.09, 2.73). In the one trial that gave data on disability using the Glasgow outcome scale, the relative risk for a poor outcome was 1.00 (95% CI 0.82, 1.22). This review does not give us enough data to be able to say whether hypertonic crystalloid is better than isotonic and near isotonic crystalloid for the resuscitation of patients with trauma, burns, or those undergoing surgery. However, the confidence intervals are wide and do not exclude clinically significant differences. Further trials which clearly state the type and amount of fluid used and that are large enough to detect a clinically important difference are needed.

Brain amino acids during hyponatremia in vivo: clinical observations and experimental studies.

Hyponatremia is a highly morbid condition, present in a wide range of human pathologies, that exposes patients to encephalopathic complication and the risk of permanent brain damage and death. Treating hyponatremia has proved to be difficult and still awaits safe management, avoiding the morbid sequelae of demyelinizing and necrotic lesions associated with the use of hypertonic solutions. During acute and chronic hyponatremia in vivo, the brain extrudes the excessive water by decreasing its content of electrolytes and organic osmolytes. At the cellular level, a similar response occurs upon cell swelling. Among the organic osmolytes involved in both responses, free amino acids play a prominent role because of the large intracellular pools often found in nerve cells. An overview of the changes in brain amino acid content during hyponatremia in vivo is presented and the contribution of these changes to the adaptive cell responses involved in volume regulation discussed. Additionally, new data are provided concerning changes in amino acid levels in different regions of the central nervous system after chronic hyponatremia. Results favor the role of taurine, glutamine, glutamate, and aspartate as the main amino acid osmolytes involved in the brain adaptive response to hyponatremia in vivo. Deeper knowledge of the adaptive overall and cellular brain mechanisms activated during hyponatremia would lead to the design of safer therapies for the hyponatremic patient.