Simethicone to prevent colonic bubbles during CT colonography performed with polyethylene glycol lavage and iohexol tagging: a randomized clinical trial.

OBJECTIVE: The purpose of this study was to determine whether the occurrence of numerous colonic bubbles during CT colonography (CTC) performed with polyethylene glycol cleansing and oral iohexol fecal/fluid tagging could be prevented by use of simethicone. SUBJECTS AND METHODS: Adults with suspected colonic neoplasia who had been randomly assigned to control and simethicone intervention groups underwent CTC after cleansing with 4 L of polyethylene glycol, tagging with 50 mL of 350 mg I/mL oral iohexol, and without (control) or with (intervention) oral administration of 200 mg of simethicone. Colonic segments in the control and intervention groups were evaluated for amount of colonic bubbles during CTC. A 6-point grading system was used in which 0 indicated no bubbles and 5 indicated that more than three fourths of the air-distended mucosa was covered with bubbles. The primary endpoint was a per-patient colonic bubble grade, derived as an average of the segmental grades. RESULTS: Eighty adults with suspected colonic neoplasia were randomly assigned to the control (40 patients) and simethicone intervention (40 patients) groups. A total of 659 colonic segments in the control group and 689 segments in the intervention group were evaluated for amount of colonic bubbles during CTC. The per-patient colonic bubble score was significantly lower in the simethicone intervention group than in the control group. The mean score was 0.0±0.1 (SD) versus 1.2±0.8 (p<0.001; 95% CI for the mean difference, -1.4 to -1.0). In the intervention group, 673 (97.7%) segments were grade 0, and 16 (2.3%) were grade 1. In contrast, in the control group, 226 (34.3%) segments were grade 0; 173 (26.3%), grade 1; 175 (26.6%), grade 2; 45 (6.8%), grade 3; 23 (3.5%), grade 4; and 17 (2.6%), grade 5. CONCLUSION: The colonic bubbles associated with fecal/fluid tagging with iohexol can be successfully prevented by adding simethicone to the colonic preparation.

Effect of subconjunctivally injected liposome-encapsulated tissue plasminogen activator on the absorption rate of subconjunctival hemorrhages in rabbits.

PURPOSE: To evaluate the effect of subconjunctivally injected liposome-encapsulated tissue plasminogen activator (tPA) on the absorption rate of subconjunctival hemorrhages (SHs). METHODS: SHs were induced in 1 eye each of 36 rabbits by subconjunctival injection of 0.05 mL of autologous blood. After 8 hours, randomized subconjunctival injections were performed: 26,000 IU/mL liposome-encapsulated tPA (0.05 mL) in 9 eyes (group A), free-form tPA (26,000 IU/mL; 0.05 mL) in 9 eyes (group B), only liposomes (0.05 mL) in 9 eyes (group C), or no injection in 9 eyes (group D). The sizes of the SHs at 8, 24, 48, 72, 96, and 120 hours after induction were measured using an image analyzer and were compared among the 4 groups. RESULTS: Group A showed significantly more rapid absorption rates than all the other groups at 24, 48, and 72 hours and had the significantly shortest mean elapsed time for the complete resorption of SHs. The tPA activity in ocular tissue except conjunctiva and plasma were negligible beyond 24 hours after SH induction with both forms of tPA. In the conjunctiva, the tPA activity was significantly prolonged in the liposome-encapsulated tPA group than in the free tPA group. CONCLUSIONS: Subconjunctival injection of liposome-encapsulated tPA seems to enhance SH absorption in rabbits, especially during the early stages with minimal systemic and ocular absorption.

Subconjunctivally injected, liposome-encapsulated streptokinase enhances the absorption rate of subconjunctival hemorrhages in rabbits.

Liposome-encapsulated streptokinase (SK) was prepared with distearoyl-phosphatidyl-ethanolamine-N-[methoxy(polyethyleneglycol)-2000] (DSPE-PEG(2000)). In vitro release assay demonstrated over 81% of SK was released from liposomes at 48 h, and the effect of its subconjunctival injection on the absorption rate of induced subconjunctival hemorrhage (SH) in rabbits was evaluated. After 8h of SH induction, eyes were randomly assigned to one of four subconjunctival injection groups (10 eyes each): group A: the free form of SK (1000 IU/mL); group B: liposome-encapsulated SK (1000 IU/mL); group C: 0.1 mL of liposomes; and group D: no injection. SHs were photographed at 8, 24, 48, 72, and 120 h after SH induction and their sizes were compared. Size decrease of the SH was faster in groups A and B than in groups C and D. Group B displayed significantly different absorption rates than group A at 24 and 48 h and with groups C and D at 24, 48, and 72 h, with the shortest mean elapsed time among all groups. The ocular absorption of SK was lower after the injection of the liposome-encapsulated SK than the free form. These results demonstrated that subconjunctival injection of liposome-encapsulated SK enhances the rate of SH absorption, especially in the early phases.