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Hypertonic Saline (hypertonic + saline)
Terms modified by Hypertonic Saline Selected AbstractsReview article: Hypertonic saline use in the emergency departmentEMERGENCY MEDICINE AUSTRALASIA, Issue 4 2008Colin J Banks Abstract Hypertonic saline (HS) is being increasingly used for the management of a variety of conditions, most notably raised intracranial pressure. This article reviews the available evidence on HS solutions as they relate to emergency medicine, and develops a set of recommendations for its use. To conclude, HS is recommended as an alternative to mannitol for treating raised intracranial pressure in traumatic brain injury. HS is also recommended for treating severe and symptomatic hyponatremia, and is worth considering for both recalcitrant tricyclic antidepressant toxicity and for cerebral oedema complicating paediatric diabetic ketoacidosis. HS is not recommended for hypovolaemic resuscitation. [source] Pulmonary edema in the transurethral resection syndrome induced with mannitol 5%ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2009J. H. WANG Two patients developed the transurethral resection (TUR) syndrome after having absorbed mannitol 5% during TUR of the prostate. Both developed pulmonary edema and became severely hypoatremic (lowest serum sodium 99 and 97 mmol/l, respectively). Hypertonic saline was infused to raise the serum sodium level and plasma volume expansion used to combat hypotension. One patient also required positive-pressure ventilation and intravenous administration of norepinephrine. Both patients recovered completely [source] Hypertonic saline in critical care: a review of the literature and guidelines for use in hypotensive states and raised intracranial pressure,ANAESTHESIA, Issue 9 2009G. F. Strandvik Summary Hypertonic saline has been in clinical use for many decades. Its osmotic and volume-expanding properties make it theoretically useful for a number of indications in critical care. This literature review evaluates the use of hypertonic saline in critical care. The putative mechanism of action is presented, followed by a narrative review of its clinical usefulness in critical care. The review was conducted using the Scottish Intercollegiate Guidelines Network method for the review of cohort studies, randomised-controlled trials and meta-analyses. The review focuses specifically on blood pressure restoration and outcome benefit in both haemorrhagic and non-haemorrhagic shock, and the management of raised intracranial pressure. Issues of clinical improvement and outcome benefit are addressed. Hypertonic saline solutions are effective for blood pressure restoration in haemorrhagic, but not other, types of shock. There is no survival benefit with the use of hypertonic saline solutions in shock. Hypertonic saline solutions are effective at reducing intracranial pressure in conditions causing acute intracranial hypertension. There is no survival or outcome benefit with the use of hypertonic saline solutions for raised intracranial pressure. Recommendations for clinical use and future directions of clinical research are presented. [source] Hypertonic saline attenuates end-organ damage in an experimental model of acute pancreatitisBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 10 2000C. J. Shields Background Hypertonic saline (HTS) has been noted previously to reduce neutrophil activation. The aim of this study was to elucidate the effect of hypertonic resuscitation on the development of end-organ damage in an animal model of pancreatitis. Methods Pancreatitis was induced in Sprague,Dawley rats by intraperitoneal injection of 20 per cent l -arginine. Animals were randomized into four groups (each n = 8): controls; pancreatitis without intervention; pancreatitis plus intravenous resuscitation with normal saline (0·9 per cent sodium chloride 2 ml/kg) at 24 and 48 h; or HTS (7·5 per cent sodium chloride 2 ml/kg) at these time points. Pulmonary endothelial leakage was assessed by measurement of lung wet: dry ratios, bronchoalveolar lavage protein and myeloperoxidase activity. Results Animals that received HTS showed less pancreatic damage than those resuscitated with normal saline (1·0 versus 3·0; P = 0·04). Lung injury scores were also significantly diminished in the HTS group (1·0 versus 3·5; P = 0·03). Pulmonary neutrophil sequestration (myeloperoxidase activity 1·80 units/g) and increased endothelial permeability (bronchoalveolar lavage protein content 1287 ,g/ml) were evident in animals resuscitated with normal saline compared with HTS (1·22 units/g and 277 ,g/ml respectively; P < 0·02). Conclusion HTS resuscitation results in a significant attenuation of end-organ injury following a systemic inflammatory response to severe pancreatitis. © 2000 British Journal of Surgery Society Ltd [source] Hypertonic saline nasal provocation and acoustic rhinometryCLINICAL & EXPERIMENTAL ALLERGY, Issue 4 2002J. N. Baraniuk Summary Background Hypertonic saline (HTS) acts as an airway irritant in human nasal mucosa by stimulating nociceptive nerves and glandular secretion. HTS does not change vascular permeability. In asthma, HTS causes airflow obstruction. Objective To determine the effect of HTS on mucosal swelling using acoustic rhinometry (AcRh). Potential vasodilator effects were controlled by maximally constricting mucosal vessels with oxymetazoline (Oxy). Method Normal subjects had AcRh before and 30 min after either 0.05% Oxy or saline (0.9% NaCl) nasal treatments. Nasal provocations followed immediately with five step-wise incremental escalating doses of HTS administered at 6-min intervals. AcRh was performed 1, 3 and 5 min after each HTS administration, and then after blowing the nose at 5 min. The minimum cross-sectional area (Amin), volume of the anterior 6 cm of nasal cavity (V6) and incremental changes from pre-drug treatment baseline levels (,, mean ±,SEM) were calculated. Results Oxy increased Amin by 46% (, = 0.48 ± 0.07 cm2, P = 0.0001) and V6 by 53% (, = 9.9 ± 1.5 mL, P < 1 × 10,7) during the first 30 min. Saline (vehicle) treatment had no effect. The maximum HTS dose had no effect after 1 or 3 min. However, in the 4th and 5th minutes there were reductions in Amin (, = 0.07 ± 0.03 cm2, P = 0.035) and V6 (, = 1.57 ± 0.42 mL, P = 0.004) with an increase in the weight of secretions (, = 700 ± 100 mg, P < 0.05). Blowing the nose returned Amin and V6 towards baseline. Oxy had no effect on HTS-induced changes in Amin, V6, pain, rhinorrhea or weight of secretions. Conclusion HTS induced nociceptive nerve stimulation and mucus secretion, and reduced V6 and Amin. Oxy caused vasoconstriction but did not alter HTS-induced effects. HTS may stimulate neurogenic axon response-mediated glandular secretion that contributes to perceptions of nasal obstruction in normal subjects. [source] Hyponatremia and Heart Failure,Treatment ConsiderationsCONGESTIVE HEART FAILURE, Issue 1 2006Domenic A. Sica MD Hyponatremia as it occurs in the heart failure patient is a multifactorial process. The presence of hyponatremia in the heart failure patient correlates with both the severity of the disease and its ultimate outcome. The therapeutic approach to the treatment of hyponatremia in heart failure has traditionally relied on attempts to improve cardiac function while at the same time limiting fluid intake. In more select circumstances, hypertonic saline, loop diuretics, and/or lithium or demeclocycline have been used. The latter two compounds act by retarding the antidiuretic effect of vasopressin but carry with their use the risk of serious renal and/or cardiovascular side effects. Alternatively, agents that selectively block the type 2 vasopressin receptor increase free water excretion without any of the adverse consequences of other therapies. Conivaptan, lixivaptan, and tolvaptan are three such aquaretic drugs. Vasopressin receptor antagonists will redefine the treatment of heart failure-related hyponatremia and may possibly evolve as adjunct therapies to loop diuretics in diuretic-resistant patients. [source] Autologous Vein Transplantation for Correction of Dermal Atrophic ChangesDERMATOLOGIC SURGERY, Issue 5 2002Guillermo Blugerman MD background. Many filling substances are useful in correcting dermal defects and/or wrinkles. objective. To describe a novel autologous dermal implant. method. Unwanted leg/hand veins and/or varicose veins are extracted in an ambulatory phlebectomy technique. The veins are then either chopped into pieces and injected into the defect or inserted whole after cellular destruction with 23.4% hypertonic saline. results. Excellent correction of dermal defect has been obtained with long-lasting and possible permanent results. No complications have occurred. conclusion. Autologous vein collagen transplantation can correct dermal defects with long-lasting and perhaps permanent results. [source] Sex differences in cerebral injury after severe haemorrhage and ventricular fibrillation in pigsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2010E. SEMENAS Background: Experimental studies of haemorrhagic shock have documented a superior haemodynamic response and a better outcome in female animals as compared with male controls. Such sexual dimorphism has, nevertheless, not been reported after circulatory arrest that follows exsanguination and shock. We aimed to study differences in cerebral injury markers after exsanguination cardiac arrest in pre-pubertal piglets. The hypothesis was that cerebral injury is less extensive in female animals, and that this difference is independent of sexual hormones or choice of resuscitative fluid. Methods: Thirty-two sexually immature piglets (14 males and 18 females) were subjected to 5 min of haemorrhagic shock followed by 2 min of ventricular fibrillation and 8 min of cardiopulmonary resuscitation, using three resuscitation fluid regimens (whole blood, hypertonic saline and dextran, or acetated Ringers' solution plus whole blood and methylene blue). Haemodynamic values, cellular markers of brain injury and brain histology were studied. Results: After successful resuscitation, female piglets had significantly greater cerebral cortical blood flow, tended to have lower S-100, values and a lower cerebral oxygen extraction ratio. Besides, in female animals, systemic and cerebral venous acidosis were mitigated. Female piglets exhibited a significantly smaller increase in neuronal nitric oxide synthase (nNOS) and inducible nitric oxide synthase (iNOS) expression in their cerebral cortex, smaller blood,brain-barrier (BBB) disruption and significantly smaller neuronal injury. Conclusion: After resuscitation from haemorrhagic circulatory arrest, cerebral reperfusion is greater, and BBB permeability and neuronal injury is smaller in female piglets. An increased cerebral cortical iNOS and nNOS expression in males implies a mechanistic relationship with post-resuscitation neuronal injury and warrants further investigation. [source] Hyper osmolality does not modulate natriuretic peptide concentration in patients after coronary artery surgeryACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2009E. L. HONKONEN Background: The heart secretes natriuretic peptides (NPs) in response to myocardial stretch. Measuring NP concentrations is a helpful tool in guiding treatment. It has been suggested that sodium ion and hyperosmolality could affect NP excretion. If this is true, peri-operative NP measurements could be inconsistent when hypertonic solutions are used. With different osmolalities but equal volumes of hydroxyethyl starch (HES) , and hypertonic saline (HS) , infusions, this double-blinded study tested the hypothesis that osmolality modulates the excretion of NPs. Methods: Fifty coronary surgery patients were randomized to receive within 30 min 4 ml/kg either HS or HES post-operatively. Samples for analysis of atrial NP (ANP), brain NP (BNP), plasma and urine sodium and osmolality and urine oxygen tension were obtained before and 60 min after starting the infusions and on the first post-operative morning. The haemodynamic parameters were measured at the same time points. Results: Plasma osmolality and sodium increased only in the HS group. Changes in plasma BNP and ANP levels did not differ between the groups (P=0.212 and 0.356). There were no correlations between NP levels and osmolality or sodium at any time point. In the HS group, urine volume was higher (3295 vs. 2644 ml; P<0.05) and the need for furosemide treatment was less (0.4 vs. 3.8 mg; P<0.01) than in the HES group. Conclusions: The absence of effects of plasma sodium content or hyperosmolality on NP release validates the value of NPs as a biomarker in peri-operative patients. [source] Lesions of the Diagonal Band of Broca Enhance Drinking in the RatJOURNAL OF NEUROENDOCRINOLOGY, Issue 10 2003M. J. Sullivan Abstract This study examined the role of the diagonal band of Broca (DBB) in drinking behaviour and vasopressin release. Adult male rats were anaesthetized (pentobarbital 50 mg/kg) and received DBB injections of either ibotenic acid (0.5 µl of 5 µg/µl) or vehicle (0.5 µl of phosphate-buffered saline). Although baseline drinking and urine output were not affected, drinking to 30% polyethylene glycol (MW 8000; 1 ml/100 g s.c.) and angiotensin II (0, 1.5 and 3.0 mg/kg s.c.) were significantly increased in ibotenic acid in phosphate-buffered saline (DBBX) rats. Drinking to hypertonic saline (0.9, 4 and 6%; 1 ml/100 g), and water deprivation were not significantly affected. DBBX rats had significantly lower basal heart rates than controls but the cardiovascular responses to infusions of angiotensin II (100 ng/kg/min i.v. for 45 min) were not affected. DBBX rats had significantly higher basal vasopressin, but angiotensin-stimulated vasopressin release was not significantly different. Although the DBB is not involved in basal water intake, it is involved in dipsogenic responses to hypovolemic stimuli and possibly basal autonomic function and basal vasopressin release. [source] Immune effect of hypertonic saline: fact or fiction?ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2004J. A. Kølsen-Petersen Hypertonicity affects many parts of the immune system. Animal studies and experiments in isolated cell cultures show that hypertonicity reversibly suppresses several neutrophil functions and at the same time up-regulates T-lymphocyte function. Infusion of hypertonic saline with or without colloids may thus, besides providing efficient plasma volume expansion, ameliorate the detrimental consequences on the immune function of trauma, shock, reperfusion, and major surgery. However, the few clinical studies conducted to date, specifically addressing the immune effect of hypertonic saline infusion, have shown little, if any, effect on markers of immune function, and larger clinical trials have not demonstrated benefit in terms of morbidity or mortality. Thus, as opposed to animal and cell-culture studies, the immune-modulating properties of hypertonic saline infusion would appear to be of limited value in clinical practice. This review presents in vitro studies, animal experiments, and clinical trials which investigated the consequences of hypertonic saline on markers of immune function. [source] Hypersaline nasal irrigation in children with symptomatic seasonal allergic rhinitis: A randomized studyPEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 2 2003Werner Garavello Recent evidence suggests that nasal irrigation with hypertonic saline may be useful as an adjunctive treatment modality in the management of many sinonasal diseases. However, no previous studies have investigated the efficacy of this regimen in the prevention of seasonal allergic rhinitis-related symptoms in the pediatric patient. Twenty children with seasonal allergic rhinitis to Parietaria were enrolled in the study. Ten children were randomized to receive three-times daily nasal irrigation with hypertonic saline for the entire pollen season, which had lasted 6 weeks. Ten patients were allocated to receive no nasal irrigation and were used as controls. A mean daily rhinitis score based on the presence of nasal itching, rhinorrea, nasal obstruction and sneezing was calculated for each week of the pollen season. Moreover, patients were allowed to use oral antihistamines when required and the mean number of drug assumption per week was also calculated. In patients allocated to nasal irrigation, the mean daily rhinitis score was reduced during 5 weeks of the study period. This reduction was statistically significantly different in the 3th, 4th and 5th week of therapy. Moreover, a decreased consumption of oral antihistamines was observed in these patients. This effect became evident after the second week of treatment and resulted in statistically significant differences during the 3th, 4th and 6th week. This study supports the use of nasal irrigation with hypertonic saline in the pediatric patient with seasonal allergic rhinitis during the pollen season. This treatment was tolerable, inexpensive and effective. [source] Pharmacotherapy of impaired mucociliary clearance in non-CF pediatric lung disease.PEDIATRIC PULMONOLOGY, Issue 11 2007A review of the literature Abstract Mucoactive agents are used to treat a variety of lung diseases involving impaired mucociliary clearance or mucus hypersecretion. The mucoactive agents studied most frequently are N-acetylcysteine (NAC), recombinant human DNase (rhDNase), and hypertonic saline. Studies on the efficacy of these have been mainly conducted in adults, and in patients with cystic fibrosis (CF). The exact role of mucoactive agents in children with non-CF lung disease is not well established. We present an overview of the current literature reporting clinical outcome measures of treatment with NAC, rhDNase, and hypertonic saline in children. 2007;42:989,1001. © 2007 Wiley-Liss, Inc. [source] Safety and use of sputum induction in children with cystic fibrosis,PEDIATRIC PULMONOLOGY, Issue 4 2003Ranjan Suri MRCPCH Abstract We assessed the safety and use of induced sputum (IS) in children with cystic fibrosis (CF). Forty-eight children (19 males) with CF, mean age 12.6 (range, 7.3,17.0) years and median forced expired volume in 1 sec (FEV1) 48% (range, 14,77%) predicted were recruited. Patients spontaneously expectorated sputum and then performed sputum induction by inhalation of nebulized 7% hypertonic saline. Samples were sent for bacteriological culture, and for measurement of the following inflammatory mediators: interleukin-8, myeloperoxidase, eosinophil cationic protein, and neutrophil elastase activity. FEV1 was performed before and after inhalation of hypertonic saline. There was no increase in mediator levels in IS compared to expectorated sputum (ES) samples. Only 3 patients demonstrated significant bronchoconstriction following inhalation of hypertonic saline, by the method used. From the ES samples, Pseudomonas aeruginosa was isolated in 13 patients, Staphylococcus aureus in 7 patients, Stenotrophomonas maltophilia in 1 patient, and both Pseudomonas aeruginosa and Staphylococcus aureus in 5 patients. All these organisms were found in the IS samples. However, in 2 patients whose ES grew no organisms, one patient's IS grew Pseudomonas aeruginosa, and the other patient's IS grew Staphylococcus aureus. In our study, sputum induction was safe, with no proinflammatory effect. Pediatr Pulmonol. 2003; 35:309,313. © 2003 Wiley-Liss, Inc. [source] Current and future use of the mannitol bronchial challenge in everyday clinical practiceTHE CLINICAL RESPIRATORY JOURNAL, Issue 4 2009Celeste Porsbjerg Abstract Objectives:, Asthma is a disease associated with inflammation, airway hyperresponsiveness (AHR) and airflow limitation. Clinical diagnosis and management of asthma often relies on assessment of lung function and symptom control, but these factors do not always correlate well with underlying inflammation. Bronchial challenge tests (BCTs) assess AHR, and can be used to assist in the diagnosis and management of asthma. Data Source:, Data presented at the symposium ,Use of inhaled mannitol for assessing airways disease' organised by the Allied Respiratory Professionals Assembly (9) of the European Respiratory Society (ERS) at the ERS Congress, Berlin 2008. Results:, Indirect challenge tests such as exercise testing, hypertonic saline or adenosine 5,-monophosphate (AMP) are more specific though less sensitive than direct challenge tests (such as methacholine) for identifying patients with active asthma. Indirect BCTs may be used to diagnose exercise-induced bronchoconstriction or AHR consistent with active asthma, to evaluate AHR that will respond to treatment with anti-inflammatory drugs and to determine the effectiveness and optimal dosing of such therapy. An ideal indirect challenge test should be standardised and reproducible, and the test result should correlate with the degree of airway inflammation. The mannitol BCT provides a standardised and rapid point-of-need test to identify currently active asthma, and is clinically useful in the identification of patients with asthma who are likely to benefit from inhaled corticosteroid therapy. Conclusion:, In the future, mannitol BCT may be added to lung function and symptom assessment to aid in the everyday management of asthma. Please cite this paper as: Porsbjerg C, Backer V, Joos G, Kerstjens HAM and Rodriguez-Roisin R. Current and future use of the mannitol bronchial challenge in everyday clinical practice. The Clinical Respiratory Journal 2009; 3: 189,197. [source] Monitoring asthma therapy using indirect bronchial provocation tests,THE CLINICAL RESPIRATORY JOURNAL, Issue 1 2007John D. Brannan Abstract Objectives:, Bronchial provocation tests that assess airway hyperresponsiveness (AHR) are known to be useful in assisting the diagnosis of asthma and in monitoring inhaled corticosteroid therapy. We reviewed the use of bronchial provocation tests that use stimuli that act indirectly for monitoring the benefits of inhaled corticosteroids. Data Source:, Published clinical trials investigating the effect of inhaled corticosteroids on bronchial hyperresponsiveness in persons with asthma were used for this review. Study Selection:, Studies using indirect stimuli to provoke airway narrowing such as exercise, eucapnic voluntary hyperventilation, cold air hyperventilation, hypertonic saline, mannitol, or adenosine monophosphate (AMP) to assess the effect of inhaled corticosteroids were selected. Results:, Stimuli acting indirectly result in the release of a variety of bronchoconstricting mediators such as leukotrienes, prostaglandins, and histamine, from cells such as mast cells and eosinophils. A positive response to indirect stimuli is suggestive of active inflammation and AHR that is consistent with a diagnosis of asthma. Persons with a positive response to indirect stimuli benefit from daily treatment with inhaled corticosteroids. Symptoms and lung function are not useful to predict the long-term success of inhaled corticosteroid dose as they usually resolve rapidly, and well before inflammation and AHR has resolved. Following treatment, AHR to indirect stimuli is attenuated. Further, during long-term treatment, asthmatics can become as non-responsive as non-asthmatic healthy persons, suggesting that asthma is not active. Conclusions:, Non-responsiveness to indirect bronchial provocation tests following inhaled corticosteroids occurs weeks to months following the resolution of symptoms and lung function. Non-responsiveness to indirect stimuli may provide a goal for adequate therapy with inhaled corticosteroids. Please cite this paper as: Brannan JD, Koskela H and Anderson SD. Monitoring asthma therapy using indirect bronchial provocation tests. The Clinical Respiratory Journal 2007;1:3,15. [source] Effect of hypertonic saline on electrocardiography QRS duration in rabbit model of bupivacaine toxicity resuscitated by intravenous lipidANAESTHESIA, Issue 8 2010G. Cave Summary Intravenous lipid emulsion is established therapy for bupivacaine induced cardiotoxicity. The benefit of combined hypertonic saline and lipid treatment is unexplored. In this experiment, sedated rabbits were resuscitated from bupivacaine-induced asystole with intravenous lipid according to the Association of Anaesthetists of Great Britain and Ireland's guideline, or by identical lipid dosing with hypertonic saline: 6 mEq.kg,1 21% sodium chloride. Early electrocardiography QRS prolongation was less with lipid plus hypertonic saline (mean (SD) QRS 0.19 (0.07) s lipid only vs 0.09 (0.01) s lipid plus hypertonic saline; p = 0.003) at 9 min though not different from the lipid only group at 20 min. No difference was observed in rates of circulatory return (7/10 lipid only and 9/10 lipid plus hypertonic saline; p = 0.58) or survival (5/10 lipid only and 6/10 lipid plus hypertonic saline; p = 1.00). Some benefit to cardiac conduction may be afforded by hypertonic saline co-administered with lipid emulsion in bupivacaine-induced cardiotoxicity. [source] Hypertonic saline in critical care: a review of the literature and guidelines for use in hypotensive states and raised intracranial pressure,ANAESTHESIA, Issue 9 2009G. F. Strandvik Summary Hypertonic saline has been in clinical use for many decades. Its osmotic and volume-expanding properties make it theoretically useful for a number of indications in critical care. This literature review evaluates the use of hypertonic saline in critical care. The putative mechanism of action is presented, followed by a narrative review of its clinical usefulness in critical care. The review was conducted using the Scottish Intercollegiate Guidelines Network method for the review of cohort studies, randomised-controlled trials and meta-analyses. The review focuses specifically on blood pressure restoration and outcome benefit in both haemorrhagic and non-haemorrhagic shock, and the management of raised intracranial pressure. Issues of clinical improvement and outcome benefit are addressed. Hypertonic saline solutions are effective for blood pressure restoration in haemorrhagic, but not other, types of shock. There is no survival benefit with the use of hypertonic saline solutions in shock. Hypertonic saline solutions are effective at reducing intracranial pressure in conditions causing acute intracranial hypertension. There is no survival or outcome benefit with the use of hypertonic saline solutions for raised intracranial pressure. Recommendations for clinical use and future directions of clinical research are presented. [source] Osmotic demyelination syndrome following rapid correction of hyponatraemiaANAESTHESIA, Issue 1 2008D. M. Snell Summary We report a case of a young male with adrenal hypoplasia who presented following water intoxication with severe hyponatraemia and seizures. He required a period of intensive care and over the initial 24 h his serum sodium corrected at average of 0.9 mmol.l,1 h,1. He subsequently developed osmotic demyelination syndrome. Following supportive treatment he made a full recovery. Severe hyponatraemia carries a risk of cerebral oedema with a significant mortality, yet correcting it too rapidly can result in osmotic demyelination syndrome, again with potentially disastrous consequences. It may be difficult to determine the duration and aetiology of the hyponatraemia and this is necessary to guide treatment. There is no consensus about the optimal rate of correction of hyponatraemia but formulae such as the Adrogue and Madias formula can be used to guide treatment with normal or hypertonic saline. Continuous veno-venous haemofiltration has been used effectively in this setting. [source] 2351: Intravenous hypertonic saline reduces intraocular pressureACTA OPHTHALMOLOGICA, Issue 2010M HARJU Purpose To study the effect of intravenous hypertonic saline (HTS) solution on intraocular pressure (IOP). Methods Nineteen patients (mean age ±SD, 66 ± 11 years) with glaucoma and IOP ,30 mmHg were recruited. HTS solution with sodium chloride concentration of 7,5% (Natriumklorid Braun 234 mg/ml, B.Braun Medical Oy, ) was given intravenously in an antecubital vein. IOP was measured every minute for 10 minutes and less frequently for up to 2 hours after treatment. The dosage given was 0,5 mmol/kg in 11 patients (Group05) and 1,0 mmol/kg in eight patients (Group1). Results The maximum mean (±SD) IOP reduction was achieved 5 minutes after treatment at which point mean IOP had reduced from 40 ± 11 mmHg before treatment to 33 ± 12 mmHg (P < 0.001). The mean percentage IOP reduction was 20 ± 10 % (range 8% , 40%) and the absolute IOP reductions ranged 4 to 16 mmHg. Two hours after treatment, mean IOP was still reduced to 33 ± 13 mmHg (P< 0.001). There was no difference between Group05 and Group1 in the amount of IOP reduction, but there was a trend that the IOP reduction sustained longer in Group1. Four patients reported mild to severe pain in the arm after injection. Especially patients in Group1 had a feeling of warmth in the head and neck region. These symptoms lasted for 1-2 minutes. Conclusion Intravenous HTS solution reduces IOP within minutes after injection. [source] Mannitol challenge for assessment of airway responsiveness, airway inflammation and inflammatory phenotype in asthmaCLINICAL & EXPERIMENTAL ALLERGY, Issue 2 2010L. G. Wood Summary Background Assessment of airway inflammation in asthma is becoming increasingly important, as the inflammatory phenotype underpins the treatment response. Objective This study aimed to evaluate mannitol as a tool for assessing airway responsiveness and airway inflammation in asthma, compared with hypertonic saline. Methods Fifty-five subjects with stable asthma completed a hypertonic (4.5%) saline challenge and a mannitol challenge at two separate visits, performed 48,72 h apart, in random order. Results Induced sputum was obtained from 49 (89%) subjects during the saline challenge and 42 (76%) subjects during the mannitol challenge (P>0.05). There was a significant correlation between the greatest percentage fall in forced expiratory volume in 1 s (FEV1) (r=0.6, P<0.0001), the dose,response slope (r=0.73), cumulative dose (r=0.55) and PD15 (r=0.46) for mannitol and hypertonic saline. The greatest percentage fall in FEV1 to mannitol was less in non-eosinophilic asthma. There was a lower total cell count in mannitol vs. hypertonic-saline-induced sputum. However, sputum eosinophils and neutrophils were not significantly different. Using mannitol, a higher proportion of subjects were classified as having eosinophilic asthma. There were no differences in IL-8, neutrophil elastase or matrix-metalloproteinase 9 concentrations in sputum samples induced with mannitol or hypertonic saline. Conclusion We conclude that mannitol can be used to induce good-quality sputum, useful for analysis of inflammatory mediators and for predicting the inflammatory phenotype in asthma. Cite this as: L. G. Wood, H. Powell and P. G. Gibson, Clinical & Experimental Allergy, 2010 (40) 232,241. [source] Bronchial hyper-responsiveness to hypertonic saline and blood eosinophilic markers in 8,13-year-old schoolchildrenCLINICAL & EXPERIMENTAL ALLERGY, Issue 8 2004G. De Meer Summary Background In adult asthma, bronchial hyper-responsiveness (BHR) to indirect stimuli reflects eosinophilic activation more closely than BHR to stimuli that directly cause smooth muscle contraction. Aim To assess the relationship between BHR to the indirect stimulus hypertonic saline (HS), blood eosinophil numbers, and serum eosinophilic cationic protein (ECP) in children with and without current wheeze. Methods A cross-sectional survey among 8,13-year-old schoolchildren, using the International Study of Asthma and Allergic disease in Childhood questionnaire, bronchial challenge with HS, skin prick tests, serum IgE, blood eosinophil counts and ECP (in a subset). Based upon the presence of current wheeze (WHE) and BHR, we defined three case groups (WHE+BHR+, WHE,BHR+, WHE+BHR,) and the reference group (WHE,BHR,). By regression analyses, each case group was compared with the reference group for differences in atopic sensitization, blood eosinophil counts and serum ECP. Results Complete data were obtained for 470 children. BHR was present in 103 children (22%), 66 being asymptomatic and 37 symptomatic. Children of all three case groups were more often atopic. Sensitization to indoor allergens particularly occurred in children with BHR, irrespective of symptoms (P<0.05). Children with WHE+BHR+ had highest values for blood eosinophils and serum ECP (P<0.05). Children with WHE,BHR+ had less severe responsiveness. In atopic children with WHE,BHR+, serum ECP was higher than in children with WHE-BHR-(P<0.05). Conclusions BHR to HS is associated with blood markers of eosinophilic activation, particularly in atopic children. [source] | |||||||||||||||||||||||||