Use of jet insulin injection in diabetes mellitus therapy.
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The authors report one case of torsade de pointe which occurred immediately after fast intravenous injection of a 1-gram dose of erythromycin lactobionate in a female patient who had undergone surgical replacement of the mitral and triscuspid valves 24 hours before. The responsibility of erythromycin was strongly suggested by the clinical data (syncope), electrocardiographic findings (electrocardiogram typical of torsade de pointe, slow rhythm and lengthened QT interval in the basal ECG) and the chronology of the sequence of intravenous injection of the antibiotic and the rhythm disorder. A literature search revealed six similar cases. Its seems that the arrythmogenic property of this drug is related to abnormally elevated serum levels following rapid administration.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
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Studies with 4 lots of group A meningococcal polysaccharides in 458 adult human volunteers showed that such vaccines are nontoxic and highly immunogenic. Comparisons of jet injection and subcutaneous (needle) methods of administration showed that both were equally immunogenic.
Needleless injection or jet injection of medication has had a rather limited clinical use in children's healthcare beyond mass vaccinations. Medications injected into children with a needle-free system include local anesthetic agents, sedatives (midazolam), and anesthetic induction agents (ketamine). Reports suggest that local discomfort is often negligible and costs are often minimal. Risks associated with this simple and flexible technique are considered to be markedly less than alternative approaches, such as syringe and needle. Further investigations are needed to confirm initial reports and establish current and other uses of jet injectors in children.
PURPOSE: We describe a new, modified jet injection technique for local anesthesia for no-scalpel vasectomy without the use of a needle, which may minimize the fear of vasectomy in men due to the needle involved in local anesthesia. MATERIALS AND METHODS: A MadaJet Medical Injector (MADA Medical Products, Carlstadt. New Jersey) was used in this study to deliver a high pressure spray of 0.1 cc local anesthetic solution directly through the scrotal skin down onto the tissue around the vas. Two or 3 jet injections are delivered to each vas and a total of 4 to 6 suffice for the entire vasectomy. RESULTS: No-needle jet injection is remarkably effective for local anesthesia for no-scalpel vasectomy. The average volume of anesthetic solution per jet injection is 0.1 cc with 0.2 to 0.3 cc for each vas. Onset is almost immediate, within 10 to 20 seconds after injection. About 465 patients were anesthetized by the jet injection technique with great satisfaction. The average visual analog scale score for the pain of the jet injection itself was 1.71 of 10. The average visual analog scale score for the pain of subsequent vasectomy during the surgical procedure was 0.66 of 10 (median 0.2). No hematomas were noted. Patients experience the mild discomfort of a pinch, not unlike a rubber band, with the first injection. CONCLUSIONS: No-needle anesthesia with jet injection is a new technique to deliver rapid onset of profound local anesthesia to the patient undergoing vasectomy. It is a simple and safe approach with high patient satisfaction, as reflected in low pain scores. The benefit of this technique without a needle is that it may decrease the fear of pain in men and enhance the popularity of vasectomy worldwide.
The use of Jet injection in insulin administration pointed out the question whether this route could affect insulin absorption and plasma insulin profiles. To compare plasma insulin profiles following an administration of an identical insulin dose by jet injection or by conventional subcutaneous route (syringe with needle) 8 healthy subjects (age 24-28 yrs., non obese) were given at 09.00 h of two different days 200 mU/kg/BW of human semisynthetic regular insulin (Novo Actarapid) alternatively subcutaneously by a syringe with needle or transcutaneously by jet injection (DG 77 - Sicim - Gorizia). Before insulin administration and then 15, 30, 60, 90, 120 and 180 minutes after, blood samples were drawn for plasma insulin and C-peptide determination. Higher plasma insulin levels after administration by jet were found at 15' and 30' minutes (62,58 +/- 6,31 v.s. 36,94 +/- 3,31 microunits/ml at 15' and 76,51 +/- 9,60 v.s. 51,65 +/- 9,95 at 30', p less than 0,01 and p less than 0,005, paired Student t test). No difference could be observed for the other times. C-peptide was found to fall to undetectable values, confirming the nearly total suppression of endogenous insulin production. It is concluded that total regular insulin absorption does not differ after transcutaneous jet injection or administration by syringe with needle, but in the first case it is faster. This last finding should be considered in planning insulin treatment schedules.
In a study to compare the immunogenicity of human diploid cell rabies vaccine (HDCV) given by intramuscular or automatic intradermal jet injection, neither method of administration resulted in antibody levels predicted by previous studies. 49 days after starting a series of three 0.1 ml doses of HDCV given intradermally, 85 volunteers had a geometric mean titre (GMT) of neutralising antibody to rabies of 1:170. 9 concurrent control subjects who received 1.0 ml doses of vaccine intramuscularly had a GMT of only 1:269. Although standard potency testing did not demonstrate that the vaccine used was subpotent , these results strongly suggest that the immunogenicity of HDCV is substantially less than previously reported.
Possible side effects to two commercial influenza vaccines (Alorbat and Begrivac S) were investigated in 893 adults (18-60 years). Both vaccines, administered by jet injections, were similarly tolerated. About 90% of vaccinated subjects had neither subjective nor objective reactions. Swelling or pain at the site of injection was reported by 11.5% of those vaccinated by Alorbat, 4.5% complained of not feeling well but only 1.1% had verifiable disorders. Local reactions occurred in 12.4% of those receiving Begrivac S, with 7.7% systemic reactions of which 1.1% were verifiable. Those re-vaccinated had a similar incidence of side reactions to those with primary vaccinations. Reactions which did occur were obviously due to the vaccination method. One person had urticaria and oedema, possibly due to reaction to foreign protein; this would suggest that the degree of purity of the vaccine should be checked by the manufacturers.
Basic fibroblast growth factor (bFGF) was prepared from bovine pituitary glands and evaluated for its effect on the viability of pedicle skin flaps in rats. Pedicle flaps measuring 3 x 7.5 cm and based cephalad were created on the backs of animals. The treatment group received bFGF in saline solution intradermally by Dermo-jet injection 30 minutes before flap elevation. Skin flaps treated with a single application of 80 U of bFGF demonstrated a significant increase in viability from 40.8% to 69.7% of the flap area (p less than 0.001); the flaps treated with 16 U of bFGF exhibited little improvement. Intradermal administration of bFGF to pedicle skin flaps produced an increase in viability that approximates the increase obtained by a surgical delay procedure; treatment of flaps with exogenous bFGF may offer advantages over surgical delay procedures.
A procedure for intrapulmonary endolymphatic therapy is described. Transthoracic intrapulmonary administration of antibiotics was performed with a needle jet injector (NJI-1). Pharmacokinetics of penicillin after its transthoracic intrapulmonary administration to patients was studied. Investigation of elimination of the antibiotics after their administration with NJI-1 showed that the main part of the antibiotics (up to 70 per cent) accumulated in the endolymphatic system of the lungs. Favourable clinical effects of the antibiotic needle jet injection were observed in the patients with acute nonspecific pulmonary diseases: decreased hospitalization terms and lower total course doses of the antibiotics.
The tissue culture vaccine against smallpox has some important advantages over the dermal preparation: it is free from bacterial contamination, contains no serum proteins, and suitable for intradermal inoculation with jet injections. The virus for the tissue culture smallpox vaccine is grown in Japanese quail embryo cultures controlled for the absence of contaminating viruses. In trials of the tissue culture smallpox vaccine in 800 revaccinated volunteers no untoward reactions or complications were observed. The antigenic activity of the tissue culture smallpox vaccine was superior to that of dermal vaccine used in the same dose: the geometric mean neutralizing antibody titre after vaccination with the tissue and dermal preparations was 1 : 256 and 1 : 158, respectively, and the antibody rise was 4.5- and 2.5-fold.
The effects of prehospital streptodecase administration on clinical course, pattern of necrosis formation, myocardial contractility and blood coagulation were studied in 15 patients with acute myocardial infarction. Patients to whom thrombolytic and anticoagulant therapy was contraindicated made up the control group. A single intravenous jet injection of the total streptodecase dose (3,000,000 U) is well tolerated by patients with acute myocardial infarction without preliminary testing. Prehospital use of the drug contributes to rapid stabilization and limitation of progressive myocardial necrosis, and improves thereby the clinical course of the disease.
A constant infusion, indicator dilution technique for blood flow measurements in the forearm and hand of man was tested and validated in vitro and in vivo. This technique employs jet injection to improve mixing of indicator with arterial blood. The mixing characteristics of the jet injection system were studied in vitro in tubing simulating the brachial artery of man. In addition, actual blood flows in the isolated pump-perfused forelimbs of five dogs were compared with constant infusion, indicator dilution calculated flows. Measurements were also made of mixing and of blood flow in the forearm and hand of man. The technique was used to compare forearm and hand vascular responses with constant intrabrachial arterial infusions of magnesium sulfate in 13 normotensive and 13 essential hypertensive men. In vitro and in vivo the jet injection system significantly improved mixing of indicator with blood, as compared with mixing produced by standard infusion techniques, without causing hemolysis. In 30 measurements in isolated, perfused dog forelimbs the correlation coefficient between actual and calculated blood flow was 0.992. Resting limb vascular resistance in the hypertensive group was significantly higher than in the normotensive group. Limb vascular resistance in all 26 men decreased in response to intrabrachial-arterial infusion of 0.25% magnesium sulfate (8 ml/min). Rate of infusion of Mg(++) was 0.162 mEq/min. There was a significant positive linear correlation between level of initial limb vascular resistance and magnitude of response to magnesium sulfate. Vascular response data adjusted for this source of variation were similar in hypertensives and normotensives.The data suggest that this constant infusion, indicator dilution technique allows accurate calculation of total limb blood flow in man, provided that anomalous bifurcation of the brachial artery is not present. The data also suggest that the jet injection system improves mixing of substances with arterial blood. Thus, use of this system should especially aid reliability of studies of limb vascular responses to vasoactive agents infused into the brachial artery.
This study was designed to evaluate, using compartmental model analysis, the effects of jet injection, changes in injected dosage, and mixture of short- and intermediate-acting insulin preparations on the absorption kinetics of human insulin (HI) mainly in rabbits. The following results were obtained. (1) It was found that a split-pool model was adequate for the evaluation of the absorption kinetics of insulin. (2) Jet injection resulted in more rapid absorption of insulin than needle injection. Since parameter K12 (inter-pool rate constant) of jet injection was three times as large as that of needle injection, the accelerated absorption by jet injector could result from the rapid movement of insulin from the injection site to the absorption site. (3) A negative correlation between insulin dosage and Kd (degradation rate constant) was observed, suggesting that the process of subcutaneous absorption of insulin includes a nonlinear component. (4) The prompt injection of Actrapid HI mixed with Monotard HI in a single syringe caused a delayed absorption of Actrapid HI. In contrast, there was no prolonged absorption after the injection of regular HI mixed with NPH-HI in a single syringe. There was a significant positive correlation between the percent change of K12 (in separate injection and mixed injection) in vivo and the recovery rate of short-acting insulin when mixed with intermediate-acting insulin in vitro. In clinical studies of diabetic subjects, higher serum free insulin levels before noon and higher K12 values were observed after the mixed injection of regular HI and NPH-HI, compared with that of Actrapid HI and Monotard HI. These results suggest that the application of compartmental model analysis is useful to studying the absorption kinetics of subcutaneously injected insulin.