Characterization of the surface physico-chemistry of plasticized PVC used in blood bag and infusion tubing.

Commercial infusion tubing and blood storage devices (tubing, blood and platelets bags) made of plasticized PVC were analyzed by spectroscopic, chromatographic and microscopic techniques in order to identify and quantify the additives added to the polymer (lubricants, thermal stabilizers, plasticizers) and to put into evidence their blooming onto the surface of the devices. For all the samples, deposits were observed on the surface but with different kinds of morphologies. Ethylene bis amide lubricant and metallic stearate stabilizers were implicated in the formation of these layers. In contact with aqueous media, these insoluble deposits were damaged, suggesting a possible particulate contamination of the infused solutions.

Studying DEHP migration in plasticized PVC used for blood bags by coupling Raman confocal microscopy to UV spectroscopy.

Plasticized PVC is widely used to make medical devices such as tubing, perfusion bags and blood bags. By using confocal Raman microscopy on a PVC sheet plasticized with around 40% of di-(2-ethylhexyl)phthalate (DEHP), we propose a simple and sensitive approach to studying and understanding the diffusion of plasticizers from polymers into the surrounding media. Moreover, we sought to correlate our findings to standard measurements conducted by UV spectroscopy. This study showed differences in the concentration gradient observed due to the diffusion of the plasticizer inside a PVC sheet. We can thus follow the critical DEHP ratios that can impact the diffusion process. Water and ethanol were chosen as storage media: in ethanol, the lowest concentration of DEHP was observed at the surface resulting in the formation of a less plasticized layer near the interface; unlike ethanol, PVC sheets stored in water showed a greater concentration of DEHP on the film surface as an exudation of DEHP onto the surface.

Impact of the nature and concentration of plasticizers on the ability of PVC to sorb drug.

The sorption of a drug by an infusion set may dramatically reduce the drug delivery efficiency. In this paper, we investigated how the drug sorption, in static conditions, is affected by the plasticizer's nature and ratio in the case of plasticized PVC, one of the most common material for infusion set tubing. Within the study, the drug concentration in diazepam solutions was studied after contact with PVC films containing different amounts of DEHP, DEHT, TOTM and DINCH® plasticizers. Moreover the partition coefficients between material and water were calculated. The drug sorption levels were equivalent for the different plasticizers and there was a plasticizer ratio for which the drug uptake was enhanced. As a consequence, the amount of sorbed drug might not be only linked to the amount of plasticizer in the film and to the solubility of the drug in the plasticizer alone: it must probably depend on specific interactions between plasticizer and PVC.

Olmesartan-associated enteropathy: results of a national survey.

BACKGROUND: Recently, a new enteropathy has been described: olmesartan-associated enteropathy. However, the association has been questioned: a phase 3 trial and a cohort study found no association between gastrointestinal events and olmesartan. AIM: To collect French cases of sartan-associated enteropathy to describe further this entity, confirm or refute causality, and determine if the association exists with other sartans. METHODS: French gastroenterologists were invited to report cases of sartan-associated enteropathy and collect clinical, biological and histological data. Patients with diarrhoea and histological duodenal abnormalities were included. RESULTS: Thirty-six patients with olmesartan-associated enteropathy were reported, including 32 with villous atrophy and four without. There was only one patient with irbesartan-associated enteropathy. None of the patients died. Patients with villous atrophy had diarrhoea, vomiting, renal failure, hypokalaemia, body weight loss and hypoalbuminaemia. Thirty-one patients were hospitalised; four required intensive care. Anti-transglutaminase and anti-enterocyte antibodies were negative; anti-nuclear antibodies were positive (9/11). Endoscopic duodenal biopsies showed villous atrophy (32/32) and polyclonal intra-epithelial CD3+CD8+ lymphocytosis (11/11). Exactly, 14/15 patients responded to steroids and/or immunosuppressants, prescribed because of suspected autoimmune enteropathy. Ten olmesartan interruptions were followed by reintroductions before steroids or immunosuppressants. Interruptions were followed by remissions (9/10), but reintroductions were followed by relapses (9/9). Twenty-nine patients were in remission since olmesartan interruption, including 26 without immunosuppressants. Patients with normal villi had similar clinical characteristics, but mild histological abnormalities (intra-epithelial lymphocytosis and lamina propria lymphocytic infiltration). CONCLUSIONS: Olmesartan causes a severe and immune-mediated enteropathy, with or without villous atrophy. Enteropathy associated with other sartans seems to be very rare.

[Extra-abdominal desmoid tumor. Microscopic aspects and histogenesis]. / Tumeur desmoïde extra-abdominale. Aspects microscopiques et histogenèse.

Extra-abdominal desmoid is an unusual and underreported tumour in dermatological literature. We report a new case of such a lesion which was subjected to light, electron-microscopic and immunohistochemical studies. The results showed that proliferating cells exhibit features of myofibroblasts, both at the ultrastructural study (presence of cytoplasmic myofilaments) and the immunohistochemical study (cytoplasmic expression of vimentin and muscle-specific actin). Since these findings strongly suggest that desmoid tumour originates from myofibroblasts the term (extra-abdominal) "myofibroblastoma" could be proposed.

[Genital chlamydia infections and extrauterine pregnancy]. / Genitale Chlamydieninfektionen und Extrauteringravidität.

Serum samples of 217 patients with ectopic pregnancy (e.p.) and of 152 women with intrauterine pregnancy (i.u.p.) were examined for their antibody content to chlamydia trachomatis by means of the indirect immunofluorescence technique. In 81% of the sera of patients with e.p., antibody could be detected, while patients with i.u.p. revealed antibody in 39%. Titres greater than or equal to 1:128 were found in 49% (e.p.) and in only 11% (i.u.p.) respectively; so they possess a high diagnostic value. These results show significant differences in the behaviour of antibodies in both groups of patients and are illustrated in 2 charts. Anamnestic data showed 54% of the patients with e.p. (i.e. adnexitis 23%, gonorrhea 12.3%, previous e.p. 18.4%); the mean age was 29 years. Affected tubes may lose their physiological function, possibly resulting in an ectopic pregnancy. The level of antibody in the serum remains stabile for many years, this enables a retrospective diagnosis of chlamydial infections. An early diagnosis and treatment, including the partners, represent the best way for prevention of complications.