Comparison of the analgesic effects of meloxicam and carprofen administered preoperatively to dogs undergoing orthopaedic surgery

Thirty-two dogs undergoing operations to repair a torn cranial cruciate ligament or a fractured long bone were randomly allocated to one of two treatment groups in a study on postoperative pain. Sixteen of the dogs were given 4 mg/kg carprofen and the other 16 were given 0.2 mg/kg meloxicam subcutaneously before the operation. The signs of pain shown by the animals were assessed for 24 hours on a visual analogue scale, a discontinuous scoring system, and a score based on five behavioural and physiological variables. The dogs' heart and respiratory rates and their mean arterial blood pressures were also measured non-invasively at each assessment. Blood samples were taken before the surgery and 24 hours after it, and the concentrations of urea and creatinine were measured in plasma. Both drugs were effective in relieving the signs of pain for up to 24 hours in all the dogs. There were no significant changes in the concentrations of urea and creatinine, and no adverse effects were reported during the postoperative period.

[Spanish contribution to the clinical development of eletriptan: an analysis of controlled studies]

INTRODUCTION

Eletriptan is a recently marketed second-generation triptan with a potent agonist activity on 5-HT1B/ 1D receptors. Our aim has been to analyze the specific results from the Spanish participation in phase IIIa and IIIb clinical trials vs placebo and compare them with the results obtained in the global clinical development of eletriptan.

PATIENTS AND METHODS

Analysis of the results obtained in 40 centers in Spain (358 patients) vs global sample 4,677 patients) for the first migraine attack in 6 controlled clinical trials with eletriptan 40 mg, eletriptan 80 mg and placebo. This ad hoc analysis was carried out for those treatment groups with more than 50 patients, which reduced the final number of patients from Spain to 250.

RESULTS

The proportion of patients with relief at 2 hours (main endpoint) in the Spanish sample was 22 %, 59 % and 67 % for placebo, eletriptan 40 mg and eletriptan 80 mg, respectively. These values were significantly higher (p < 0.05) than those of placebo and similar to those from the total sample. The proportion of pain free patients at 2 hours in the Spanish sample was 10 %, 36 % and 41 % for placebo, eletriptan 40 mg and eletriptan 80 mg, respectively. These values were significantly better than those for placebo (p < 0.05) and about 15 %-20 % higher than those from the total sample. Recurrence rate in the Spanish sample was 50 %, 16 % and 25 % for placebo, eletriptan 40 and eletriptan 80 mg, respectively, and did not differ from that of the total sample. Sustained relief for the two eletriptan doses was 46 % for both eletriptan 40 and eletriptan 80, this being significant (p < 0.05) over placebo (11 %) for the Spanish sample and similar to that of the global sample. The results for other efficacy parameters, such as need of rescue medication, functional response at 2 hours, complete response for pain-freeness and acceptability followed a similar pattern. Eletriptan was, in general, well-tolerated. Adverse events were slight-moderate in intensity, transient and were not different, either in profile or proportion, from those from the global sample.

CONCLUSIONS

These results confirm eletriptan 40 mg and 80 mg as an excellent option for the symptomatic treatment of migraine in our setting.

Hydroxyapatite-coated external-fixation pins

Pin loosening and infection are inherent complications of external fixation. This study deals with their effects of using either hydroxyapatite (HA)-coated or uncoated external fixation pins in leg-lengthening procedures on patients of short stature.

We used HA-coated pins on one side and uncoated pins on the other (randomly determined) in 28 bilateral lengthenings undertaken in 23 patients. A total of 322 pins was used. The mean implantation time was 530 days and the mean lengthening achieved was 78% of initial bone length. Mean extraction torque was 7611.6 Nmm degree−1 for HA-coated and 85.4 Nmm degree−1 for uncoated pins (p < 0.001). The rate of pin loosening was 4% (7/ 161) for HA-coated and 80% (129/161) for uncoated pins (p < 0.001). There was no statistically significant difference in the incidence of pin-track infection between the two groups.

The use of HA coating appears to be an effective method of reducing the incidence of pin loosening in external fixation with a long implantation time and for mechanically highly stressed procedures such as leg lengthening for short stature.

Experimental and theoretical vibrational study of 2,2,2-trifluoroethyl trifluoromethanesulfonate, CF3SO2OCH2CF3

The infrared spectra of 2,2,2-trifluoroethyl trifluoromethanesulfonate (CF3SO2OCH2CF3) were obtained in the gaseous, liquid and solid states as well as the Raman spectrum of the liquid. Quantum chemistry calculations using the density functional theory were used to predict the most stable geometry and conformation of the studied molecule. Subsequently, the harmonic vibrational frequencies and force field were calculated. An assignment of the observed spectral features made after comparison with the related molecules and with the predicted frequencies was used as the basis of a scaling of the original force field in order to reproduce as well as possible the experimental frequencies. With this purpose a set of scale factors was calculated by a least square procedure, leading to a final root mean square deviation (RMSD) of 9.7 cm(-1).

[De novo hemolytic uremic syndrome in a kidney-pancreas recipient in the postoperative period]

Among the numeruos adverse side effects of tacrolimus (TAC), de novo thrombotic microangiopathy stands out as an infrecuente but severe complication. Renal dysfunction is the only alteration that should lead to suspicion of thrombotic microangiopathy, because the clinical features of intravascular hemolysis are not always found. The definitive diagnosis can usually be made with kidney biopsy. Patientes with TAC induced thrombotic microangiopathy usually promptly recover after treatment withdrawal or reduction in the dose of TAC and a short course of plasma therapy, but the risk of rejection increases. Switching from TAC to cyclosporine has also been tried with resolution of the hemolysis but thrombotic microangiopathy has been noted with both and this condition may later recur. We present a 29-year-old man who received a kidney-pancreas transplant for end-stage diabetic nephropathy. After initial induction with basiliximab, the immunosuppression consisted of prednisone, tacrolimus and mycophenolate mofetil. Twenty four days posttransplantation his renal function declined with a peak creatine level of 2.35 mg/dl. Laboratory studies showed thrombocytopenia and features of intravascular hemolysis. TAC associated hemolytic uremic syndrome was suspected and drug was immediately stopped and converted to sirolimus. Also he was treated with plasma infusion. The allograft biopsy showed focal glomerular and arteriolar acute thrombosis without evidence of rejection. Our experience demostrate that switching from tacrolimus to sirolimus could be an adecuate strategy for patients who develop FK506-associated de novo thrombotic microangiopathy without increase risk of acute rejection.

Prophylactic treatment of episodic cluster headache with intravenous bolus of methylprednisolone

We evaluated the efficacy of intravenous boluses of methylprednisolone followed by prednisone as a prophylactic treatment for episodic cluster headache. Fourteen male patients (mean age, 42.54 years) with episodic cluster headache were treated with 250-mg boluses of methylprednisolone on 3 consecutive days, followed by prednisone (90 mg/day orally) with gradual tapering in four weeks. Headache parameters of the active phases treated with methylprednisolone were compared with those of previous active phases in the same patients treated with other prophylactic medications. The primary efficacy criterion was decrease in the frequency of attacks during the first month of treatment. The statistical differences were calculated using Wilcoxon's test. The attacks were significantly less frequent in the active phases treated with methylprednisolone boluses than those treated with other medications ( p<0.05). This treatment seems to be more effective than the usual prophylactic treatments for episodic cluster headache.

Evaluation of transplant procurement management courses: an educational project as a tool for the optimization of transplant coordination

The process of obtaining organs and tissues includes a series of procedures and skills that are fundamental to obtain a large number and high quality of transplants. Health professionals involved in transplant coordination require robest and comprehensive training to integrate the donation-transplantation process within the clinical health care field. Based on a learning-through-experience model, Transplant Procurement Management (TPM) designed various courses adapted to local educational need to train transplant coordinators, to increase active donor detection, and to promote a positive attitude towards donation; namely, Advanced, Introductory and New Life Cycle courses respectively. Moreover, TPM has coordinated international programs (INTERCATT and INTERITALY). Since 1991, the model has included 29 Advanced courses (1215 participants), 22 Introductory courses (575 pupils), and 7 New Life Cycle courses (more than 400 attendees). The Advanced courses were attended by medical (intensive care unit, nephrology, and others) and nursing professionals. Assessment of the educational program showed achievement of teaching objectives. The evaluation averages above 3.5 (scale, 1-5) for content, presentation, and ability to answer questions. Likewise, the program's organization showed an average score of 4.4. The acquired knowledge was assessed by means of a self-evaluation test (correct answers >69%). Practical skills assessed through direct observation showed an average of 7 (scale, 1-10). The TPM educational program offers a range of necessary knowledge and skills to increase organ donation. Health professionals concerned about the organ shortage may find TPM training useful to increase their knowledge.

The process of adult living liver donation

OBJECTIVE

To evaluate both the opinion that living liver donors have of the process and the psychological, economic, and social consequences of donation.

MATERIAL AND METHODS

Six months after the donation, an anonymous survey was sent to 22 donors of the right liver lobe between March 2000 and December 2002.

RESULTS

15 surveys were returned with all of the questions answered. Almost all the donors had no prior knowledge of living donation. When they were considered to be suitable donors, all of them felt happy, 21% were scared and 15% felt joy and insecurity. The information provided was well understood and accurately described the experiences of 93% of donors. All donors understood the vital risk, and 93% understood that transplantation is not always completely successful. All donors would repeat the experience. Mean hospital stay was 12.6 days. Mean convalescence was 50.6 days. Salaried donors were on sick leave for a mean of 96.4 days (21-150 days), causing financial problems in six cases (36%), due to no financial compensation and compulsory redundancy in one case. All donors had completely recovered at six months after donation.

DISCUSSION

Adult living donation of the right liver lobe is an accepted therapeutic alternative. In order to regulate medical and economic protection to avoid additional disturbances after donation, the public, patients, and physicians require more complete information about living donation.

Persistence of intracranial diastolic flow in transcranial Doppler sonography exploration of patients in brain death

OBJECTIVE

The persistence of cerebral blood flow (CBF) in patients with whole brain death (BD) diagnosis is an unusual phenomenon. We describe patients with whole BD diagnosed despite persistence of intracranial blood flow on transcranial Doppler sonography (TDS).

MATERIALS AND METHODS

From January 2001 to December 2002, we reviewed the records of 11 patients. Etiology of BD was craniocephalic trauma in 2 cases, schemic cerebrovascular accident (CVA) in 4 cases, Hemorrhagic CVA in 3 cases, subaracnoid hemorrhage in 1 case, and acute hydrocephalus in 1 case. Six patients had a cerebral decompressive mechanism. In all patients, TDS was used to confirm BD after clinical diagnosis. Additionally, all patients underwent an electroencephalogram (EEG). In 3 patients cerebral angiography (CA) and in 2 others radionuclide angiography (RA) with Tc99m HMPAO were done.

RESULTS

All TDS studies showed persistent telediastolic positive flow in at least 1 artery. Because the TDS did not confirm the clinical diagnosis of BD, EEG tests were performed showing silence of bioelectrical activity. Those cases showed CA or RA results with a complete absence of CBF.

CONCLUSION

The TDS technique directly evaluates the intracranial but not the intracerebral circulation. For this reason, during the BD diagnosis for patients with previous decompressive techniques, it was possible to find persistence of intracranial telediastolic flow using TDS. In those cases, it is advisable to use other tests to confirm the clinical diagnosis of BD.

The living kidney donation process: the donor perspective

OBJECTIVE

To evaluate the living kidney donation (LKD) process using donors' opinions on the impact on social, emotional, and financial aspects affecting donor quality of life.

MATERIALS AND METHODS

From May 2000 to December 2002, we studied 22 donors of living kidneys at the Hospital Clinic, Barcelona, Spain, who completed an anonymous survey 6 months after donation.

RESULTS

Most donors (86%) had themselves informed the recipient about their wish to donate, the other 14% were asked by family members. Eighty-eight percent stated that the information provided to the donor about the evaluation process was well explained and understood whereas 12% disagreed with the statement. At the time of thin decision, 90.5% of donors understood the vital risk. For 95%, the explanations about the process corresponded with the actual experience. One hundred percent of donors stated after donation that they would again favor it. Mean hospital stay was 6 days (range, 3-9 days). Those donors with a labor contract have been out of work for an average of 57.8 days (range, 18 days to 6 months). Twenty-five percent of donors admitted financial effects as a result of donation. All but 1 felt completely recovered with the same quality of life after donation.

DISCUSSION

LKD is a good therapeutic alternative. Some aspects should be developed, such as more information about living donation and the need to considering donors as healthy persons without loss of earnings. Recognition of the benefits of living donation requires more wide participation of all citizens nationally.

Cold chain monitoring during cold transportation of human corneas for transplantation

BACKGROUND

As recommended by international standards the cornea should be maintained in a specific temperature range (2 degrees -8 degrees C) to guarantee its viability. However, there is no standard packaging method to maintain these conditions during transport. Our packaging system is similar to those used by the main eye banks in Spain and elsewhere in Europe. The objective is to monitor the cold chain in the current packaging method to validate the maintenance of temperature within the adequate range for a minimum 24-hour period.

METHODS

The effects of the following variables were studied: number and freezing temperature of the cold packs; air volume in the packaging system; position of the cornea in the packaging system; and the wall section of the container. Exterior temperature was maintained constant at 20 degrees to 24 degrees C. The cold chain was monitored using a device that measures temperature continuously and for which a histogram of temperature variation can be downloaded to a computer for further analysis.

RESULTS

When the cold packs were frozen to -40 degrees C or the number of cold packs increased to four, the temperature decreased quickly to 0 degrees C and the transport period was not prolonged. The main objective was to improve isolation by reducing inner air volume, and maintaining the position of the cornea in the container.

CONCLUSIONS

The currently used cold packaging systems (not frozen, 4 degrees C) do not maintain the temperature within the accepted range for the required distribution period. The improved system maintains the cornea at between 2 degrees C and 6 degrees C for a minimum of 24 hours.

Hydroxyapatite coating of external fixation pins to decrease axial deformity during tibial lengthening for short stature

BACKGROUND

Tibial valgus, a known complication of leg lengthening with external fixation techniques, has been related to the stability of the bone-fixator system and, in particular, to pin loosening. A hydroxyapatite coating has been reported to enhance the quality of the bone-pin interface. The aim of this study was to compare the prevalence of axial deformity after tibial lengthening with hydroxyapatite-coated external fixation pins with the prevalence after tibial lengthening with uncoated pins.

METHODS

We conducted a prospective study of thirty-four symmetrical tibial lengthening procedures in seventeen pathologically short patients. One limb of each patient was lengthened with use of hydroxyapatite-coated pins and the other, with standard uncoated pins; the sides of the operations were randomly selected. The bone angle in the frontal plane was measured before the operation and at the end of the fixation period, and the difference between these measurements was compared between the lengthening procedures performed with coated pins and those performed with uncoated pins.

RESULTS

The mean valgus deviation of the tibia was 6.5 degrees in the group treated with hydroxyapatite-coated pins and 12.5 degrees in the group treated with uncoated pins (p = 0.023). With the numbers available, other factors previously related to the development of valgus deformity did not differ significantly between the two groups.

CONCLUSION

Tibiae that are lengthened with the use of hydroxyapatite-coated external fixation pins are less prone to axial deviation in the frontal plane than are those treated with uncoated pins.

LEVEL OF EVIDENCE

Therapeutic study, Level I-1a (randomized controlled trial [significant difference]). See Instructions to Authors for a complete description of levels of evidence.

Lipase-catalyzed synthesis of xylitol monoesters: solvent engineering approach

A solvent engineering strategy was applied to the lipase-catalyzed synthesis of xylitol-oleic acid monoesters. The different esterification degrees for this polyhydroxylated molecule were examined in different organic solvent mixtures. In this context, conditions for high selectivity towards monooleoyl xylitol synthesis were enhanced from 6 mol% in pure n-hexane to 73 mol% in 2-methyl-2-propanol/dimethylsulfoxide (DMSO) 80:20 (v/v). On the contrary, the highest production of di- and trioleoyl xylitol, corresponding to 94 mol%, was achieved in n-hexane. Changes in polarity of the reaction medium and in the molecular interactions between solvents and reactants were correlated with the activity coefficients of products. Based on experimental results and calculated thermodynamic activities, the effect of different binary mixtures of solvents on the selective production of xylitol esters is reported. From this analysis, it is concluded that in the more polar conditions (100% dimethylsulfoxide (DMSO)), the synthesis of xylitol monoesters is favored. However, these conditions are unfavorable in terms of enzyme stability. As an alternative, binary mixtures of solvents were proposed. Each mixture of solvents was characterized in terms of the quantitative polarity parameter E(T)(30) and related with the activity coefficients of xylitol esters. To our knowledge, the characterization of solvent mixtures in terms of this polarity parameter and its relationship with the selectivity of the process has not been previously reported.