Short-term safety and effectiveness of sugammadex for surgical patients with end-stage renal disease: a two-centre retrospective study.

Sugammadex is a novel reversal agent for aminosteroid neuromuscular blocking drugs, especially rocuronium. Given its renal excretion, sugammadex is not recommended for patients with end-stage renal disease; however, reports exist of its use in this group of patients. This two-institutional retrospective observational study aimed to review the safety profile and effectiveness of sugammadex in surgical patients with end-stage renal disease who required pre-operative renal replacement therapy. Adult surgical patients with end-stage renal disease requiring pre-operative renal replacement therapy, who received sugammadex between April 2016 and January 2019, were studied. The primary outcome was the incidence of postoperative tracheal re-intubation within 48 h. The secondary outcome was the incidence of deferred tracheal extubation in the operating theatre. One hundred and fifty-eight patients were identified from 125,653 surgical patients: 48 patients (30%) underwent renal transplantation and 110 (70%) underwent non-renal transplantation procedures. There were 22 instances (14%) of deferred tracheal extubation due to surgical and/or pre-existing medical conditions. Out of the 136 patients who had the tracheal tube removed at the end of the procedure, three patients had their trachea re-intubated within 48 h: two patients developed pulmonary oedema resulting from volume overload; and one patient had worsening sepsis. No incidence of recurrence of neuromuscular blockade was observed. Of note, 24 (18%) patients were found to have incomplete neuromuscular blockade reversal with neostigmine but administration of sugammadex led to successful tracheal extubation. In conclusion, sugammadex appears to be safe and effective in adult patients with end-stage renal disease receiving pre-operative renal replacement therapy.

Effect of polyglycerol esters additive on palm oil crystallization using focused beam reflectance measurement and differential scanning calorimetry.

The effect of 0.1-0.7% (w/w) of polyglycerol esters (PGEmix-8) on palm oil crystallization was studied using focused beam reflectance measurement (FBRM) to analyze the in-line changes of crystal size distribution during the crystallization. FBRM results show that 0.1-0.5% (w/w) of PGEmix-8 did not significantly affect nucleation but slightly retarded crystal growth. The use of 0.7% (w/w) additive showed greater heterogeneous nucleation compared to those with lower dosages of additive. Crystal growth was also greatly reduced when using 0.7% (w/w) dosage. The morphological study indicated that the palm oil crystals were smaller and more even in size than when more additive was added. Isothermal crystallization studies using differential scanning calorimetry (DSC) showed increased inhibitory effects on palm oil crystal growth with increasing concentration of PGEmix-8. These results imply that PGEmix-8 is a nucleation enhancing and crystal growth retarding additive in palm oil crystallization at 0.7% (w/w) dosage.

Rare manifestations of sarcoidosis.

This case report describes a patient with sarcoidosis who developed superior vena cava syndrome, breast granuloma, and tracheobronchial stenosis, all as a direct result of the primary underlying disease. While each of these entities has been described individually as being associated with sarcoid, this is the first case in which all have occurred in the same patient.

Pneumothorax in patients with acquired immunodeficiency syndrome.

Case histories of 25 consecutive patients with acquired immunodeficiency syndrome in whom pneumothorax developed from January 1985 to the present are reviewed. Spontaneous pneumothorax developed in 10 patients. All patients had a documented pulmonary infection. Four of 10 died, either of progressive respiratory failure or of concurrent infection. Patients with asymptomatic spontaneous pneumothorax can be safely observed. Patients with symptomatic pneumothorax should initially undergo tube thoracostomy. If an air leak persists, thoracotomy, stapling of blebs, and pleurodesis can be safely performed. Because of the prevalence of bilateral disease, a median sternotomy incision is recommended. Two patients underwent surgical treatment. Diffuse bullous disease associated with infiltration of lung parenchyma by Pneumocystis carinii pneumonia was identified in both. Both patients survived and were discharged. Patients whose pneumothorax developed while they were undergoing mechanical ventilation for respiratory failure induced by Pneumocystis carinii pneumonia had a 92.3% mortality rate. In all patients surviving for longer than 7 days after development of the initial pneumothorax, a contralateral pneumothorax later developed. Severe concurrent disease made the patients poor operative candidates. However, in the absence of concurrent illness, if a persistent large air leak is believed to contribute significantly to respiratory failure, surgical intervention may be indicated.