Esophageal candidiasis as a side effect of inhaled fluticasone propionate dry powder: recovery by switching over to hydrofluoroalkane-134a beclomethasone dipropionate (HFA-BDP).

BACKGROUND: Esophageal candidiasis is one of the local side effects of inhaled corticosteroid treatment, and it is difficult to prevent this condition. Our previous report indicated that the prevalence of esophageal candidiasis among patients treated with inhaled fluticasone propionate dry powder (FP-dp) reached up to 37% in Japanese patients. Although a reduction in the daily dose of inhaled FP-dp can eliminate this infection, it may lead to asthma not being well-controlled in these patients. OBJECTIVE: The aim of this study was to estimate whether switching to an equal daily dose of inhaled hydrofluoroalkane-134a beclomethasone dipropionate (HFA-BDP), the oropharyngeal deposition of which is very low, can eliminate the infection without deterioration of asthma. METHODS: A total of 10 stable asthmatic patients with esophageal candidiasis, induced by inhaled FP-dp treatment (400 or 800 microg/ day), were enrolled in this study. A second upper GI endoscopy was performed, more than 1 month but less than 3 months after switching to an equal dose of inhaled HFA-BDP with a tube spacer device, Duopacer. The patients' medications were not changed during the study. RESULTS: Esophageal candidiasis was eliminated in 9 of the 10 patients. The degree of candidiasis reduced in another patient. The forced expiratory volume in 1 sec (FEV1.0) did not worsen during the study. CONCLUSION: Switching from FP-dp to HFA-BDP with Duopacer is useful in preventing esophageal candidiasis.

Effect of mixing ratio in lecithin/bile acid mixed micelles on Na(+)-K+ ATPase.

Lecithin and bile acid form mixed micelles in the bile. We found that the mixing ratio in lecithin/bile acid mixed micelles directly changes the activity of Na(+)-K+ ATPase. Na(+)-K+ ATPase activity was suppressed to 13.3% of that in the buffer alone at a lecithin/bile acid mixing ratio of 0.1 in the presence of 10(-2) M bile acid (that is, a concentration level close to that of the hepatic bile). With increase in the mixing ratio in the presence of 10(-2) M bile acid, the activity of the enzyme was found to be augmented accordingly. Thus addition of lecithin to an extent such that the mixing ratio reached 0.6 led to an enhancement of enzymatic activity to 193.8%. If lecithin addition is made in the presence of bile acid at the near gallbladder concentration of 10(-1) M, however, the Na(+)-K+ ATPase activity can be observed to increase with the increase in the lecithin/bile acid ratio. Yet, at the same mixing ratio of 0.6, the enzyme activity was arrested at only 25.7%. However, this change in mixing ratio had no effect on ouabain-insensitive ATPase. The state of mixed micelles may exert the same effect on Na(+)-K+ ATPase activity in vivo.

[Changes in plasma superoxide dismutase like activity during general anesthesia and surgery in man].

Superoxide radicals are highly reactive products that are known to induce various pathological changes in man. Superoxide dismutase is an enzyme that scavanges superoxide radicals. We measured plasma superoxide dismutase (SOD) like activity according to electron spin resonance using DMPO as a trap. The subjects of the study were 48 surgical patients who underwent various elective surgery. They ranged from 10 to 74 years in age. Anesthetic agents employed were enflurane in 50% O2 + 50% N2O, modified NLA with pentazocine, original NLA and fentanyl + ketamine (FK). In NLA group, 70% N2O and 30% O2 were given and 70% air and 30% O2 were administered to the patients of FK group. The mean plasma SOD like activity before the anesthetic induction in surgical patients of all groups was 5.70 +/- 0.41 U.ml-1. There is no significant difference compared with the value of normal persons. A marked reduction in plasma SOD like activity was obtained during surgery in any type of anesthesia in this study. Neither anesthetic agents used in this study nor the extent of surgery contributed to the degree of SOD like activity reduction. Surgical duration over two hours was the most contributing factor to reduce the SOD like activity. There was no correlation between plasma SOD like activity and age or serum total protein.