Impact of dry coating lactose as a brittle excipient on multi-component blend processability

Previous work demonstrated the benefits of dry coating fine-grade microcrystalline cellulose (MCC) for enabling direct compression (DC), a favored tablet manufacturing method, due to enhanced flowability while retaining good compactability of placebo and binary blends of cohesive APIs. Here, fine brittle excipients, Pharmatose 450 (P450, 19 μm) and Pharmatose 350 (P350, 29 μm), having both poor flowability and compactability are dry coated with silica A200 or R972P to assess DC capability of multi-component cohesive API (coarse acetaminophen, 22 μm, and ibuprofen50, 47 μm) blends. Dry coated P450 and P350 not only attained excellent flowability and high bulk density but also heightened tensile strength hence processability, which contrasts with reported reduction for dry coated ductile MCC. Although hydrophobic R972P imparted better flowability, hydrophilic A200 better enhanced tensile strength, hence selected for dry coating P450 in multi-component blends that included fine Avicel PH-105. For coarse acetaminophen blends, substantial bulk density and flowability increase without any detrimental effect on tensile strength were observed; a lesser amount of dry coated P450 was better. Increased flowability, bulk density, and tensile strength, hence enhanced processability by reaching DC capability, were observed for 60 wt% ibuprofen50, using only 18 wt% of the dry coated P450, i.e. 0.18 wt% silica in the blend.

[Improvement in the measurement technique of pulmonary artery pressure by Doppler echocardiography with contrast in chronic obstructive pulmonary disease]

OBJECTIVE

To evaluate the benefit of contrast echocardiography in the assessment of systolic pulmonary artery pressure (PAPs).

DESIGN

Compare standard reference (Doppler-echocardiography) with contrast.

LOCATION

Echocardiography department.

PATIENTS

Ambulatory chronic obstructive patient disease (COPD).

INTERVENTION

Continuous wave Doppler spectral signal of tricuspid regurgitation (TR) was evaluated before and after intravenous injection of a galactose-based intravenous echo-enhancing agent. A four patterns scale classified the quality of the TR signal: 0=absent regurgitation; 1=protosystolic signal not allowing the recognition of peak velocity; 2=non-homogenous signal intensity, albeit allowing the measurement of maximal velocity; and 3=uniform pansystolic velocity signal. PAPs was estimated adding 10 mm Hg to the transtricuspid gradient, calculated from the TR peak velocity.

RESULTS

PAPs was only calculated reliably in 20 (49%) patients before the administration of contrast. Seventeen patients were classified as pattern 2, and three as pattern 3 on the scale of the TR quality signal. After contrast 41 (95%) patients showed a reliable TR signal. Two were classified as pattern 1, 11 as pattern 2 and 28 as pattern 3 on the scale of the TR quality signal. In the 20 patients in whom PAPs was estimated before contrast, a significant increase in PAPs values occurred after contrast, 44±10 mm Hg vs. 56±15 mm Hg (p<0.01).

CONCLUSION

The use of an echocardiography contrast agent increases the number of COPD patients in whom PAPs can be estimated non-invasively and may avoid underestimation of the PAP value.

[Thrombolysis in acute ischemic stroke in basic hospitals. four cases reports]

Thrombolytic drugs have been used in recent years as an effective therapeutic option in ischemic stroke. There are several experiences with the administration of thrombolytic therapy in basic and rural hospitals. We are describing our experience with four cases in which this treatment was used in our basic hospital during the last three years. We used a strict protocol described in the National Institute of Neurological Disorders and Stroke (NINDS) rt-PA stroke study. No intracranial hemorrhage or protocol violations were detected. We conclude that this protocol has allowed us to offer safe treatment to our ischemic stroke patients.

Membranous fat necrosis

We report the case of a 66-year-old man with nodular lesions on the chest that were clinically diagnosed as epidermal cysts. Histologically the lesions consisted of fat necrosis with cystic spaces lined by striking membranous structures, mimicking a parasitic cuticle and exhibiting all the staining reactions of ceroid. Retrospective review of 33 consecutive cases of fat necrosis revealed similar membranous changes in 21% of the cases. The etiology and pathogenesis of this variant of fat necrosis are uncertain.

Coexistence of Castleman's disease and Kaposi's sarcoma. Report of a case and a speculation

A case report of multicentric Castleman's disease associated with Kaposi's sarcoma is presented. Histologic examinations of cutaneous lesions and of an axillary lymph node were made. The cutaneous lesions showed Kaposi's sarcoma and a lymph node revealed Castleman's disease and foci of spindle cells characteristic of Kaposi's sarcoma. The association of Castleman's disease and Kaposi's sarcoma appears too frequently to be due to chance alone. We speculate that these two entities may reflect different tissue reactions to the same causative agent.

Significance of a sixth lactate dehydrogenase isoenzyme (LDH6)

An unusual band on the cathodic side of the membrane was found on lactate dehydrogenase electrophoresis of blood specimens from 18 patients. Fifteen patients died shortly after the finding. No specific cause was found for the unique band, but most of the patients had arteriosclerotic cardiovascular disease with acute passive hyperemia of the liver, and prerenal azotemia.

Optimal enzyme test combination for diagnosis of acute myocardial infarction

One hundred consecutive patients admitted to our cardiology service with the suspected diagnosis of acute myocardial infarction were evaluated with serical enzyme and isoenzyme determinations in an attempt to develop the medically and financially optimal combination of enzyme tests. In patients with onset of chest pain less than 24 hours before admission, creatine phosphokinase MB determination on admission and after 12 hours was sufficient to diagnose of exclude myocardial infarction. One serum LDH isoenzyme determination 24 hours after admission confirmed the diagnosis in 74% of patients.

Cutaneous involvement by IgD myeloma

Multiple, firm, nontender, violaceous, cutaneous and subcutaneous nodules of the abdomen and thighs developed in a 53-year-old man with proven IgD myeloma. A biopsy specimen showed dermal infiltration by large atypical undifferentiated cells similar to those previously found on bone marrow aspiration. Despite intermittent improvement with radiotherapy and chemotherapy, the patient died and an autopsy showed multiple osteolytic lesions and massive involvement with tumors that encased the pelvic organs, infiltrated and replaced portions of the psoas muscles, infiltrated the kidneys and intestines, and replaced the bone marrow by small and intermediate-sized malignant lymphoid cells. IgD myeloma is a rare hematologic malignancy that occurs at a younger age than other forms of myeloma, has a high incidence of involvement of soft tissues, and is a particularly dedifferentiated and vicious form of myeloma.