Salivary stimulation by prolonged release of pilocarpine in sjõgren’ syndrome

Introduction: Prolonged drug delivery in the oral cavity offers many advantages, such as reducing adverse effects. Pilocarpine is an FDA-approved parasympathomimetic drug for the treatment of glandular hypofunction; however, its adverse effects limit its use. Objective: To evaluate the stimulation of salivary flow by the use of pilocarpine-releasing films, as well as their effects on the symptoms of xerostomia and adverse effects in patients with Sjõgren’s syndrome (SS). Materials and methods: Hydroxypropylmethylcellulose (Methocel K4MCR) films were prepared in 1 percent acetic acid and pilocarpine was added under magnetic stirring. The pH and thickness, as well as diffusion uniformity and kinetics of drug release per cm2 were evaluated by spectrophotometry. The films were tested sublingually in 40 patients with Sjõgren’s syndrome for a period of two weeks. Changes in their salivary flow were evaluated by analyzing samples of total saliva. Additionally, patients were screened for symptoms of xerostomia and adverse effects. Results: The films had a pH of 2.91 +/- 0.035, a thickness of 0.06866 +/- 0.00152μm, and a diffusion uniformity of 91 percent per cm2. Use of the films resulted in an increase in salivary flow in both primary and secondary Sjõgren’s syndrome, but this increase was only significant in primary SS. Conclusion: Films showed optimal physicochemical properties for their administration, and proved effective in stimulating salivary flow without causing adverse effects during their administration.

A clinical comparison between DisCoVisc and 2% hydroxypropylmethylcellulose in phacoemulsification: a fellow eye study

OBJECTIVE: This study sought to compare the effects and outcomes of two ophthalmic viscosurgical devices, 1.6% hyaluronic acid/4.0% chondroitin sulfate and 2.0% hydroxypropylmethylcellulose, during phacoemulsification. METHODS: This prospective, randomized clinical trial comprised 78 eyes (39 patients) that received phacoemulsification performed by the same surgeon using a standardized technique. Patients were randomly assigned to receive either 1.6% hyaluronic acid/4.0% chondroitin sulfate or 2.0% hydroxypropylmethylcellulose on the first eye. The other eye was treated later and received the other viscoelastic agent. Preoperative and postoperative examinations (5, 24 and 48 hours; 7 and 14 days; 3 and 6 months) included measurements of the total volume of the ophthalmic viscosurgical device, ultrasound and washout times to completely remove the ophthalmic viscosurgical device, intraocular pressure, central corneal thickness and best-corrected visual acuity. The corneal endothelial cell count was measured at baseline and at six months postoperatively. ClinicalTrials.gov: NCT01387620. RESULTS: There were no statistically significant differences between groups in terms of cataract density or ultrasound time. However, it took longer to remove 2.0% hydroxypropylmethylcellulose than 1.6% hyaluronic acid/ 4.0% chondroitin sulfate, and the amount of viscoelastic material used was greater in the 2.0% hydroxypropylmethylcellulose group. In addition, the best-corrected visual acuity was significantly better in the hyaluronic acid/ chondroitin sulfate group, but this preferable outcome was only observed at 24 hours after the operation. There were no statistically significant differences between the two ophthalmic viscosurgical devices regarding the central corneal thickness or intraocular pressure measurements at any point in time. The corneal endothelial cell count was significantly higher in the hyaluronic acid/chondroitin sulfate group. CONCLUSION: The ophthalmic viscosurgical device consisting of 1.6% hyaluronic acid/4.0% chondroitin sulfate was more efficient during phacoemulsification and was easier to remove after IOL implantation than 2.0% hydroxypropylmethylcellulose. In addition, the corneal endothelial cell count was significantly higher following the use of hyaluronic acid/chondroitin sulfate than with hydroxypropylmethylcellulose, which promoted an improved level of corneal endothelium protection.

Comparative results of gastric submucosal injection with hydroxypropyl methylcellulose, carboxymethylcellulose and normal saline solution in a porcine model / Resultados comparativos de injeção submucosa gástrica com hidroximetil celulose, carboximetilcelulose e soro fisiológico em modelo suíno

CONTEXT: Endoscopic mucosal resection is an established modality for excision of sessile lesions in the gastrointestinal tract. Submucosal fluid injection creates a cushion and may prevent thermal injury and perforation. OBJECTIVES: This blind study investigated the performance of three different solutions to create submucosal fluid cushions in porcine stomach. METHODS: Three solutions were injected in the stomach of nine pigs BR1: normal saline solution, carboxymethylcellulose 0.5 percent and hydroxypropyl methylcellulose 0.25 percent. In each pig, submucosal injections with 6 mL per test-solution were performed. One drop of methylene blue was added to all injections for better visualization. The time for the bleb to disappear was recorded. RESULTS: The overall median time of visible submucosal cushion was 37 minutes (range 12-60 min) for hydroxypropyl methylcellulose, 31 minutes for carboxymethylcellulose (range 10-43 min) and 19 minutes for normal saline solution (range 8-37 min). There was no statistically significant difference neither between normal saline solution and carboxymethylcellulose (P = 0.146) nor carboxymethylcellulose and hydroxypropyl methylcellulose (P = 0.119) but the median duration of hydroxypropyl methylcellulose was significantly longer than normal saline solution (P = 0.039). CONCLUSIONS: The length of hydroxypropyl methylcellulose submucosal fluid cushion is longer in comparison with normal saline solution. The median time for carboxymethylcellulose was not longer than normal saline solution. Hydroxypropyl methylcellulose, in the concentration of 0.25 percent, may be a durable alternative for submucosal injection.

CONTEXTO: A ressecção endoscópica mucosa é uma modalidade estabelecida para a excisão de lesões sésseis no trato gastrointestinal. A injeção de fluídos na submucosa cria uma coxim que pode prevenir lesão térmica e perfuração. OBJETIVO: Este estudo cego investiga o desempenho de três diferentes soluções para criar um coxim fluído submucoso no estômago suíno. MÉTODOS: Três soluções foram injetadas no estômago de nove porcos BR1: soro fisiológico, carboximetilcelulose 0.5 por cento e hidroxipropil metilcelulose 0.25 por cento. Em cada porco, injeções submucosas com 6 mL por solução-teste foram realizadas. Uma gota de azul de metileno foi adicionada a cada injeção para melhor visualização. O tempo de desaparecimento de cada coxim foi registrado. RESULTADOS: O tempo mediano total do coxim submucoso visível foi de 37 minutos (faixa 12-60 min) para hidroxipropil metilcelulose, 31 minutos para carboximetilcelulose (faixa 10-43 min) e 19 minutos para soro fisiológico (faixa 8-37 min). Não houve significância estatística entre soro fisiológico e carboximetilcelulose (P = 0.146), assim como entre carboximetilcelulose e hidroxipropil metilcelulose (P = 0.119), mas a duração mediana de hidroxipropil metilcelulose foi significativamente maior que a do soro fisiológico (P = 0.039). CONCLUSÃO: A duração do coxim submucoso com hidroxipropil metilcelulose é maior em comparação com o do soro fisiológico. O tempo mediano da carboximetilcelulose não foi maior que do soro fisiológico. A hidroxipropil metilcelulose, na concentração de 0.25 por cento, pode ser uma alternativa durável para injeção submucosa.

Coupling agents; comparison of efficacy of 0.3% artificial tear gel with 2.5% methylcellulose in various procedures

To find out the uses of commercially available clear lubricant eye gel as coupling agent and compare it with 2.5% methylcellulose in various procedures as 1. In Goldmann triple mirror for gonioscopy 2. In Abraham lens for Nd-YAG laser capsulotomy and iridotomy 3. In Area centralis lens for Grid laser photocoagulation 4. In Wide field lens for scatter or panretinal photocoagulation. Prospective Comparative Study. Diagnostic and research Department of Ophthalmology, Allied Hospital, PMC Faisalabad. From 1[st] July 2008 to 31[st] December 2008. Eighty patients, divided into two groups as each group having forty patients [40 eyes] One drop of topical anesthetic "Alcaine" proparacain hydrochloride was instilled twice in the eye, 5 minutes before starting the procedure. We used hydroxyprophyl methylcellulose 0.3% gel in the half of the patients eyes and used traditionally formulated hydroxypropyl methylcellulose 2.5% in the other half of the patients eyes and the findings were compared with each other. 2.5% methylcellulose was used in 40 eyes during Gonioscopy, Yag-laser iridotomy, Yag-laser capsulotomy and photocoagulation and was compared with 0.3% hydroxypropyl methylcellulose gel in the same procedures in 40 other eyes. Post procedures clarity of view comfort irrigation of solution remants, redness and stinging sensation were compared with the both coupling agents. The 0.3% gel showed good results

Viscoexpression of anterior chamber cysticercus cellulosae.

We report a case of anterior chamber Cysticercus cellulosae that was removed by viscoexpression.

Metilcelulose a 2 porcento em cirurgia intraocular / Methyl cellulose at 2 percent in intraocular surgery

Foram estudados 56 olhos de 56 pacientes submetidos a ceratoplastia e facectomia extracapsular com e sem implante de lente intraocular. A metilcelulose foi empregada para manter a câmara anterior, diminuir os danos às células endoteliais, controlar eventual pressäo vitrea, facilitar manobras cirúrgicas como inserçäo da lente intraocular "in the bag", aumentar visibilidade dos procedimentos cirúrgicos. No pós-operatório os pacientes foram observados com biomicroscopia e tonometria, visando especificamente reaçäo inflamatória de aquoso e vítreo, espessura corneana, estado endotelial e pressäo intraocular. A metilcelulose näo causou aumento de inflamaçäo, alteraçäo endotelial ou corneana em nenhum dos olhos. A pressäo intraocular que em 3 pacientes chegou a níveis entre 25 e 30 mmHg após a cirurgia, voltou aos níveis pré-operatrorios em até 3 dias. Pela primeria vez na literatura se registrou grumos transitórios provavelmente de metilcelulose aderidos ao endotelio ou na câmara anterior, que desapareceram sem sequelas. Os nossos resultados comprovam que a metilcelulose é excelente substância viscoelástica para uso em cirurgia intraocular, apresentando em relaçäo ao Healon pelo menos duas grandes vantagens: baixo custo e maior solubilidade. A metilcelulose permitiu manutençäo da câmara anterior, controle do plano vítreo, perfeita visibilidade das cápsulas anterior e posterior do cristalino e inserçäo das alças da lente "in the bag" ou no sulco