Development and validation of spectrophotometric method for phenylephrine hydrochloride estimation in nasal drops formulations

Simple, accurate and reproducible UV-spectrophotometric method was developed and validated for the estimation of phenylephrine hydrochloride in pharmaceutical nasal drops formulations. Phenylephrine hydrochloride was estimated at 291 nm in 1 mol⋅dm-3 sodium hydroxide (pH 13.5). Beer’s law was obeyed in the concentration range of 10–100 μg⋅cm−3 (r2 = 0.9990) in the sodium hydroxide medium. The apparent molar absorptivity was found to be 1.63×103 dm3⋅mol−1⋅cm−1. The method was tested and validated for various parameters according to the ICH (International Conference on Harmonization) guidelines. The detection and quantitation limits were found to be 0.892 and 2.969 μg⋅cm−3, respectively. The proposed method was successfully applied for the determination of phenylephrine hydrochloride in pharmaceutical nasal drops formulations. The results demonstrated that the procedure is accurate, precise and reproducible (relative standard deviation < 1 %), while being simple, cheap and less time consuming, and hence can be suitably applied for the estimation of phenylephrine hydrochloride in different dosage forms.

[Isolated aneurysm of the internal iliac artery and disorders of the pelvic organs functions]

BACKGROUND

Isolated aneurysm of internal iliac artery is very rare and often asymptomatic. Aneurysm itself can produce malfunction of the pelvic organs. Aneurysm rupture is followed by high mortality.

CASE REPORT

A 76-year-old patient was admitted to the hospital with abdominal and left groin pain, disuric problems, obstipation and the signs of intestinal subocclusion. These problems persisted over the last few months. Digitorectal examination showed pulsatile tumor. Computed tomography and angiography revealed isolated aneurysm of the left internal iliac artery with a maximal diametar of 13.5 cm. The aneurysm was treated operatively using extraperitoneal approach in general anestesia. During the operation a Cell Saver was used. The left internal iliac artery was resected and ligated with end-aneurysmatic suture of its branches.

CONCLUSION

Isolated aneurysm of the internal iliac artery should be considered by differential diagnosis in any case of the occurence of disorders of the pervic organs functions. Clinical findings, ultrasound examination, computed tomography and angiography are the diagnostic techniqnes of choice which can confirm the diagnosis. Surgical treatment with the use of retroperitoneal approach lead to complete recovery, so it could be considered the method of choice for patients with the condition permitting a radical surgical approach.

Primary actinomycosis of the anterior abdominal wall: case report and review of the literature

Actinomycosis of the anterior abdominal wall is a rare infection caused by different Actinomyces species. We report a case of primary actinomycosis localized on the anterior abdominal wall, diagnosed by computed tomography (CT) scan, postoperatively confirmed by histopathological examination and treated by surgical resection combined with postoperative antibiotic therapy. The patient has been free of recurrence after 1 year. A review of the available literature is also presented.

Postoperative rehabilitation in patients with peripherial nerves injury

Injuries of extremities can be followed by various neuromuscular complications. Injury of peripheral nerves directly depended on the topographic localization of injury (fractures, cuts, contusions). The neuromuscular complications were diagnosed and under follow-up, based on clinical, x-ray, neurologic and neurophysiological findings. The timing of physical treatment and assessment of the necessary neurosurgical intervention depended on the obtained findings. After surgeries, we continued to apply physical treatment and rehabilitation. The aim of the paper was to assess the significance of proper timing for surgery and adequate postoperative rehabilitation, as well as treatment results, depending on the extent of peripheral nerve injury. Material and methods: Based on the study condocted in the period from 2000-2002, most surgeries were done on the ulnar nerve (4 pts), median nerve (4 pts), radial nerve (3 pts), peroneal nerve (2 pts) and plexus brachialis (3 pts). Paresis and peripheral nerve paralysis, associated with sensibility disorders, predominated in clinical features. In most patients surgery was done during the first 3 - 6 months after injury. In early postoperative treatment positioning of extremities with electrotherapy were most often used in early postoperative treatment, Bioptron and dosed kinesitherapy. Depending on the neurophysiological findings, in later treatment stage we included electrostimulation, thermotherapy, kinesitherapy and working therapy, with the necessary application of static and dynamic orthroses. Study results showed that the success of treatment depended on the extent of injury, i.e. whether suture of liberalization of the nerve had been done, on the adequate timing of surgery, as well as on the adequate timing and application of physical therapy and rehabilitation. More rapid and complete functional recovery was achieved if the interval between injury and surgery was shorter, as well as physical therapy was applied early. Based on the analysis of the achieved results, we concluded that peripheral nerve lesions after fractures and contusions had better prognosis in relation to isolated sections of peripheral nerves, having in mind that these were mostly conductive block transfer and nerve stretching lesion, which do not leave sequelae after completed treatment After neurorrhaphies and applied therapy, motor and sensitive deficit mostly depended on good timing of surgery and continual physiatric treatment. It is also important to point out the significance of team-work among neurosurgeon, neurologist and physiatrist necessary in early detection and successful treatment of numerous sequelae and invalidity in patients with peripheral nerve lesions.

[Successful surgical treatment of a massive pulmonary embolism in the organized thromboembolic phase]

A patient, male, aged 36, clinically presented as an unstable angina pectoris following myocardial infarction, who came from general hospital of Banja Luka for further examination is presented. According to the medical report, he was treated for acute myocardial infarction in 1994 at Banja Luka's general hospital, when he was resusciated due to of cardiac arrest. The anginous pain was still present regardless of prescribed therapy. Following the clinical examination at the Military Medical Academy we have established a diagnosis of thromboembolism of the main pulmonary artery with a high pressure in the right ventricle. He underwent surgery under the extracorporeal circulation, when an organized old thrombus the main pulmonary artery and partially in arterial branches. The main pulmonary artery was almost completely obliterated. Thrombectomy was done. Following the operation, the patient was in a good condition and the repeated echocardiographic examinations showed no signs of recurrent thrombosis while the pressure in the right ventricle was significantly decreased. Afterwards, he was treated by heparine and oral anticoagulants and then by antiagregants. This case is very instructive because the massive pulmonary thromboembolism which was wrongly recognized and treated as an acute myocardial infarction.

[Therapeutic embolization of the spleen]

Spleen embolization is a method of percutaneous occlusion of instrasplenic vascular network, by which is achieved a partial embolization of arterial branches with the convenience of controlled circulation reduction. Reduction achieved in this way corrects clinical and laboratory symptoms of hypersplenism and improves hematologic status in the diseases of lymphopoietic tissues where splenectomy is otherwise the therapeutic solution. This method had been applied experimentally, and afterward clinically since 1973, but with numerous complications and incidents. The authors had discussed those complications, commented the method development, so as physiopathologic and hemodynamic circumstances, and considering them, the method had become efficacious and safe. Using the modified methodologic principle, they had performed the first transcatheter spleen embolization at the Institute for Radiology of Military Medical Academy in the patient with liver cirrhosis, hypersplenism, splenomegaly and the signs of portal hypertension. The authors described the applied methods, postintervention effects and clinical and laboratory condition in six months after the intervention. Considering the positive clinical and laboratory results, the authors are of the opinion that the method of transcatheter spleen embolization is useful therapeutic alternative to splenectomy.

[Hemodynamic significance of fluoroscopic diagnosis of coronary artery calcification]

The onset of coronary arterial calcification is an active, organized, metabolically regulated process that occurs only when the initial changes of atherosclerosis are present. Coronary arterial calcification may represent an attempt to protect the arterial wall mechanically. Determination of hemodynamic significance in detecting coronary heart disease was the aim of the study. 110 patients with suspected angina pectoris were performed fluoroscopy and coronary angiography after-wards. In 77 patients (70%) was determined coronary arteriosclerosis using coronary angiography, and in 33 (30%), finding was normal. Out of 77 (70%) patients with positive funding in 44 patients (57.14%) calcifications were detect using fluoroscopy, while in 33 (42.86%) were not. Out of 33 (30%) patients without arteriosclerosis calcifications were detected in 5 (15.15%) patients, and in 28 (84.85%) were not. According to our results and literature review, the calcification finding confirms the presence of already existing significant stenosis on the coronary artery or a high risk for hemodynamic disorder within the next two to five years.

[The value of echotomographic measurement of gallbladder volume in the evaluation of its contractility]

Ultrasonographic examination of the gallbladder was performed in 2 patient groups: 20 volunteers (group I) and 20 patients with cholelithiasis (group II). Gallbladder volume was echotomographically measured before and after holagogue was administered. Dodd's ellipsoidal method was used for the elevation of gallbladder contractility. The mean value of gallbladder contractility was 69.9% in the group of volunteers. After the holagogue administration, the decrease of gallbladder volume was noticed in all the studied patients. In group of patients with cholelithiasis, the reaction after holagogue administration was different: the increase of gallbladder volume was noticed in 8 patients after the holagogue administration and the poor gallbladder contractility (below 50%) was noticed in 8 patients. Four patients had no reaction after the holagogue administration. Echotomography was determined to be reliable method in the diagnosis of gallbladder contractility disturbances.

[Kinesitherapy in the treatement of paralysis of plexus brachialis in the newborn]

In the treatment of this deformity in a newborn infant, the priority is given to physical therapy with additional orthopaedic treatment, such as adduction splints. In our opinion the treatment of such a defect should start as soon as possible, i.e., immediately after birth. This kind of treatment is usually long and persistent. By this treatment muscular atrophy, muscular corrective contractures wich cause serious invalidism in these young patients, should be prevented. In fact, inadequately treated children remain invalids for their whole life because a deformed arm will never be in complete function. Furthermore, from the aesthetic point of view, such an arm provokes a negative feeling in other persons. Therefore, we insist on the early appropriate treatment which is the only guarantee for good results.

[Contamination of IgG preparation for intravenous use with IgA. I. Development of ELISA tests for determination of low concentrations of IgAc, IgA1, IgA2, IgG and IgM]

Very low amounts of immunoglobulin contaminants present in preparations of immunoglobulin G for intravenous use (IVIG) require sophysticated procedures for detection of such low concentrations in milieu of comparatively very high level of IgG. Standard RID and nephelometry procedures are not adequate for these purposes. In process of removal of IgA contamination from IVIG, which is currently under development in Blood Transfusion Institute, Belgrade, it is necessary to have senzitive and very specific procedures for determination of and follow up of very low concentrations of IgA remauning in IVIG. We have established a highly senzitive and specific ELISA precedures for determination of very low concentrations of total IgA (IgAc), IgA1, IgA2, IgG and IgM. Commercial standards of IgAc, IgA1, IgA2, IgG and IgM were bound to PVC plates coated with corresponding monoclonal antibodies anti IgAc-IgA1, anti-IgG and anti-IgM. Resulting standard curves have shown high correlation coeficients with limited range of detection (two orders of magnitude in nanogram range). Very high specificity of ELISA tests were obtained due to the highly specific monoclonal antibodies used. Very high specificity and very low detection level of developed tests are advantageous compared to standard procedures for Ig concentration determination.

[Contamination of IgG preparation for intravenous use with IgA. II. Removal of IgA1 from IgG preparation using affinity chomatography on lectin jacalin columns]

Administration of preparations of IgG for intravenous use (IVIG) in individuals with high anti-IgA antibody levels in circulation is frequently accompained with anafilactoid reactions. Thus, there is a requirement for preparations of IVIG with very low levels of IgA. Reduction of IgA concentration in IgG preparations is generally difficult to achieve, since physical and chemical characteristics, on which proceses for Ig purification are based on, are similar for these two Igs. In this work the ability of lectin jacalin to selectively bind IgA1 subclass was exploited for removal of IgA1 from IVIG currently under development in Blood Transfusion Institute of Republic Serbia, Belgrade. Concentrations of Igs in this preparation of IVIG were measured by ELISA tests developed for these purposes. The results have shown 280 times decrease of IgA1 content without changes of IgG concentration. Therefore, affinity chomatography on jacalin column is a suitable method for removal of IgA1 subclass from IVIG. Because of a favourable pH and ionic strength conditions used in process, this procedure has no effect on native state of IgG.

[The importance of physical therapy in the treatment of Volkmann's contracture in children]

Over the period from 1981 to 1991 twenty-eight children were treated for neurovascular posttraumatic complications (Volkman's contracture), in the Centre for rehabilitation and physical medicine of the Children's surgical department in Belgrade. The success of the treatment depended on how a patient was examined for the first time, and how soon a proper diagnosis was established. On the basis of our experience we insist on an early physical treatment, i.e. while the injured segment is immobilized. An early kinesitherapy followed later by electrotherapy, parafino-therapy, vitamin B therapy and use of corrective plaster cast splints is the best way in treating lesions. The treatment lasted from 3 to 6 months depending on the seriousness of an injury. If there was no good result with physical therapy we carried out surgery followed by physical therapy upon the removal of immobilisation devices.

[Ultrasound, computer tomography and angiography in the diagnosis of dissecting aortic aneurysm]

The findings obtained by ultrasound, CT and angiographic examinations of 75 patients with dissecting aortic aneurysms operated on at the M.M.A. are analysed. The aim of each particular method was to detect the presence of dissection, the aortic entrance tear and type of dissection. These findings were compared with the operative findings. On the basis of the analysis it has been concluded that the precision of the diagnosis obtained by angiography was 93%, by CT 74% and by ultrasound 69%.

[Hemodialysis in children and beta 2-microglobulin]

Retention of beta-2-microglobulin, due to loss of excretory renal function inevitably occurs in uremia. A significant correlation between the duration of hemodialysis and the incidence of carpal tunnel syndrome or destructive cystic lesions of bone has been reported. Amyloid deposition has been found to directly cause these lesions. This amyloid protein has been identified to be beta-2-microglobulin. The aim of this report was to study plasma beta-2-microglobulin levels in hemodialysed children and to detect clinical manifestations or carpal tunnel syndrome and of bone lesions. 12 children aged 9-24 years were studied. The average duration of dialysis was 51.9 ae 32 months. Beta-2-microglobulin plasma levels were studied before and after hemodialysis treatment. All patients were examined for carpal tunnel syndrome using clinical methods including nerve conduction studies, and for destructive cystic lesions using X-rays of bone. Plasma beta-2-microglobulin concentrations in our patients were found to be sevrefold time higher (73.8 ae 22.1 mg/l) than control values (1.6 ae 0.5 mg/l). The increase of beta-2-microglobulin concentration during hemodialysis tratment was due probably by hemoconcentration. We noted poor correlation between plasma beta-2-microglobulin and duration of hemodialysis. Any signs of carpal tunnel syndrome was found to our patients. Radiological signs of amyloid osteopathy found to be present in 3 children, was not verified by bone biopsy.