The choice of compressor effects the aerosol parameters and the delivery of tobramycin from a single model nebulizer

Recent U.S. Phase III trials of the aerosolized delivery of tobramycin to cystic fibrosis (CF) patients demonstrated a significant improvement in pulmonary function and in sputum bacterial density. These trials used the Pari LC Plus nebulizer and DeVilbiss Pulmo-Aide compressor. This compressor is not generally available in Europe, and its power requirements do not match the European power supply. Thus alternate compressors were evaluated, using the LC Plus nebulizer, in preparation for European clinical trials. Aerosol particle size distribution, nebulization time (min), and the respirable dose of tobramycin (mg within 1-5 mu) were obtained for seven compressor models. The respirable quantity delivered by each of the European compressors (240 Volts, 50 Hz) was compared to the LC Plus and PulmoAide compressor (120 Volts, at 60 Hz). The U.S. system delivered 71.4 mg of the 300 mg instilled dose within the respirable range; using the European compressors, between 63.0 and 74.8 mg was delivered. With a 97% confidence that the delivered tobramycin was within 20% of the standard, we conclude that the SystAm 23ST, MedicAid CR50 and CR60, Pari Master and the Pari Boy compressors are equivalent to the U.S. standard; the Hercules and the SystAm 26ST compressors were not statistically equivalent to the standard. Using the LC Plus nebulizer, five European compressors delivered doses of TOBI that are similar to the doses delivered by the DeVilbiss PulmoAide compressors, and thus may be expected to produce clinical results similar to those of the U.S. trials.

Development and use of a bipolar resectoscope in endometrial electrosurgery

We conducted a prospective, blinded study to compare the tissue response and mechanical properties of a bipolar resectoscope with standard monopolar cutting and coagulation instruments. At the animal care facility of Tufts Medical School (Medford, MA), four surgeons blinded to instrumentation and distention media cut segments out of a rabbit uterine horn and desiccated the abdominal wall using either the bipolar device in 0.9% saline or the monopolar system in 1.5% glycine. Both systems used a Force 2 Valleylab radiofrequency generator at identical power settings. Cut and desiccated sections were fixed and stained with hematoxylin and eosin as well as Masson's trichrome to evaluate thermal damage. The pathologist was blinded to the system used to make the cut or desiccation. Both systems cut and coagulated tissue with similar properties. Most surgeons noted a longer delay from radiofrequency activation to actual cutting with the bipolar system. The depth of thermal damage when cutting or desiccating tissue was similar for the two systems. This disposable, inexpensive device allows for standard resectoscopic hardware to be transformed into a bipolar device. All current techniques of intrauterine cutting and coagulation may soon be performed in the presence of physiologic uterine distention media. Human clinical data remain to be gathered.

Determination of dolasetron and its reduced metabolite in human plasma by GC-MS and LC

Both a GC-MS and an LC method have been developed for the simultaneous quantitation of dolasetron and reduced dolasetron in human plasma. The GC-MS method has been utilized in preliminary human pharmacokinetic studies of dolasetron mesylate. Selected ion monitoring was used in these initial studies to obtain the sensitivity and specificity required for quantitation. The GC-MS method has been used in the range of 1-120 ng ml-1 for dolasetron and 1-240 ng ml-1 for reduced dolasetron in plasma. The limit of quantitation for both compounds by GC-MS was 1 ng ml-1. Recently, an LC method has been utilized for quantitation of both compounds on a routine basis. This method utilizes essentially the same sample preparation procedure as the GC-MS method. The LC method has been used in the range of 5-200 ng ml-1 in plasma for dolasetron and reduced dolasetron. In addition, the relationship between the LC and GC-MS methods has been assessed using data obtained from human male volunteers following intravenous administration of 3.0 mg kg-1 of dolasetron mesylate monohydrate.

Potential of radio-frequency balloon angioplasty: weld strengths, dose-response relationship, and correlative histology

Previous studies have established the feasibility of combining tissue heat generated by radio-frequency (RF) current and mechanical pressure to manage problems of percutaneous transluminal angioplasty (PTA) that are thought to cause postangioplasty restenosis (PARS). In the current in vitro study of normal and atherosclerotic human aortic layers (intima-media and media-adventitia) separated artificially, the purposes were to identify a dose-response relationship between the total RF energy delivered and the resultant weld strength between vascular tissues and to study the histologic correlates. Twenty-eight control and 100 experimental specimens were evaluated. The mean weld strength for all specimens with no RF current (at 0 J) was 4.1 g +/- 2.0; at 100 J, 5.9 g +/- 2.8; at 200 J, 28.5 g +/- 3.3; at 300 J, 50.0 g +/- 5.5; and at 500 J, 82.0 g +/- 8.2. Inspection of treated specimens revealed vascular molding (depression in the surface corresponding in dimensions to those of the electrode gap in the treatment chamber). Histologic examination revealed necrosis in the region underlying the electrode gap, a hypocellular fusion zone, indistinct boundaries between welded specimen parts, and transition zones to normal histologic characteristics at either end of each specimen. RF energy combined with mechanical pressure produces dose-dependent thermal welds in artificially dissected vascular tissues, molding of vascular tissue, and cellular destruction in the media. These findings may have clinical application in the management or prevention of all forms of PARS in humans and in the treatment of spontaneous aortic dissection.

The effect of radiofrequency-generated thermal energy on the mechanical and histologic characteristics of the arterial wall in vivo: implications for radiofrequency angioplasty

Abrupt reclosure of atherosclerotic vessels after percutaneous transluminal balloon angioplasty has been blamed on traumatic dissections and elastic recoil of the vessel wall. Thermal energy with compression produces fusion of separated arterial wall layers, and heat appears to alter the elastic recoil of the vessel wall. Radiofrequency (RF) thermal energy has been used to perform vascular anastomoses and thermal angioplasty. A simple in vivo experiment was designed to describe and quantitate vascular tissue weld strength produced by a range of RF thermal energy levels. Canine carotid arteries were compressed between a pair of modified bipolar forceps that applied RF energy, causing occlusive tissue welds between the apposed intimal surfaces. The strength of the welds was evaluated by measuring the perfusion pressure required to reopen the vessel lumen. A dosimetry range of 0 to 205 joules showed a typical dose-response curve for the relationship between energy applied and bond strength, plateauing at approximately 300 mm Hg. Light microscopy showed fusion of the inner surfaces of the vessel with preservation of vessel wall architecture. Additionally inflation of a bipolar RF balloon catheter in the normal canine carotid lumen produced an alteration of vessel profile angiographically and histologically. Results of these preliminary experiments suggest that balloon angioplasty with adjunctive RF thermal energy may have benefits in reducing the factors causing acute failure of conventional percutaneous transluminal balloon angioplasty.