[Assessment of the optimization of the conditions of mitomycin C intravesical instillation completion in the setting of non-muscle invasive bladder cancer treatment]. / Évaluation de l'optimisation des conditions de réalisation des instillations endo-vésicales de mitomycine C dans le traitement des tumeurs de vessie non infiltrant le muscle.

OBJECTIVE: The efficacy of intravesical instillation of mitomycin C (MMC) requires alkalinisation and concentration of urine before each instillation. The objective of the study was to assess compliance and effectiveness of urine alkalinazation and fluid restriction protocols in patients treated with intravesical instillations of MMC for TVNIM. MATERIAL ET METHOD: Descriptive prospective epidemiological study in all patients consecutively treated with intravesical instillations of MMC for non-muscle invasive bladder cancer (NMIBC). Patients should be advised to drink 2 liters of water from Vichy and to perform fluid restriction the day before the instillations. Before each instillation, a questionnaire on the implementation of these measures was filled, density and pH were determined by urinalysis strips. RESULTS: On 126 questionnaires fulfilled, 117 patients (93%) and 106 patients (84%) reported having made alkalinization and fluid restriction, respectively. Ninety-one of patients (78%) reported having performed alkalinization had a pH greater than or equal to 6.5 and the mean urinary pH was 6.94 vs. 5.94 in patients stating not to have made alkalizing (P=0.0001). No significant differences in urine density according to fluid restriction was found. CONCLUSION: The observance of the instructions regarding urine alkalinization before MMC instillations was satisfactory and has achieved a sufficiently high urinary pH to prevent degradation of the product in 91% of cases. Conversely, the fluid restriction was not followed closely and has not shown its effectiveness on the concentration of urine.

[Cystinuria]. / Cystinurie.

Cystinuria is the most common monogenic nephrolithiasis disorder. Because of its poor solubility at a typical urine pH of less than 7, cystine excretion results in recurrent urinary cystine stone formation. A high prevalence of high blood pressure and of chronic kidney disease has been reported in these patients. Alkaline hyperdiuresis remains the cornerstone of the preventive medical treatment. To reach a urine pH between 7.5 and 8 and a urine specific gravity less than or equal to 1.005 should be the goal of medical treatment. D-penicillamine and tiopronin, two cysteine-binding thiol agents, should be considered as second line treatments with frequent adverse events that should be closely monitored.

[Dietary control of metabolic acidosis in chronic kidney disease]. / Contrôle diététique de l'acidose métabolique chez le patient insuffisant rénal chronique.

Metabolic acidosis is a frequent complication of chronic kidney disease. Although it is known to appear at advanced stages, many studies suggest a state of "global protonic retention" starting at early stages of the disease, responsible of tissue damage, particularly musculoskeletal, alteration of protidic metabolism and endocrine disorders, promoting malnutrition and chronic inflammation, and finally increasing mortality. The majority of international recommandations suggest of supplementation by alkali, most of the time by sodium bicarbonate, to struggle against this complication. An interesting alternative to correct acidosis would consist on the modulation of the endogenous production of acid by playing with the alimentary incomes. In fact, it has been demonstrated that some different types of food produce or consume protons during their metabolism. Low protein diet and rich fresh fruits and vegetables diet would manage to correct at least as well as the supplementation by sodium bicarbonate the metabolic acidosis, and to struggle against its complications, noteworthy by slowing the decline of glomerular filtration rate by limiting the toxic adaptative fibrotic mechanisms, demonstrated by the decrease of urinary tubulo-interstitial suffering markers. Of the condition of being well led, those diets do not seem to expose patients to an over-risk of malnutrition or hyperkaliemia. They therefore appear to be an attractive alternative, efficiency and safe, to fight against chronic kidney disease metabolic acidosis and its complications.

In vitro evaluation of diffusion of lidocaine and alkalinized lidocaine through the polyurethane membrane of the endotracheal tube.

OBJECTIVES: Endotracheal tube (ETT) and its inflated cuff are likely to induce specific reactivity at the emergence time. In ICU, the tolerance of the ETT cuff could be a part of patient agitation and increased of sedation. MATERIALS AND METHODS: Using specific ICU ETT cuff (thin polyurethane cuff), we perform an in vitro evaluation of diffusion of lidocaine and alkalinized lidocaine (L-B) across the PU cuff for a long duration. We evaluate the safety of this procedure by a daily injection into the cuff. RESULTS: With lidocaine alone, we observed a low rate of diffusion through the cuff (<8% over 24h), whereas the L-B solution had a high diffusion (>90% over 24h). The released profiles were similar from day 0 to day 8, and no cuff rupture was reported over the 8-day study. CONCLUSION: The safety, controlled release, and lack of deleterious effects on cuff membrane were confirmed. In case of unexpected cuff rupture, an adequate determination of the mixture allows to obtain a safe solution with the achievement of a physiological pH (7.4) and the small dose of lidocaine (40 mg).