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Discrete-trial control of morphine self-injection behaviour in monkeys: effects of injection dose and trials per session.

Responding for intravenous injections of morphine was studied using a discrete-trials procedure in squirrel monkeys. For one group, each session consisted of 10 trials at an inter-trial interval of 15 min; for the second group, each session consisted of 100 trials at an inter-trial interval of 1.5 min. When different injection doses of morphine (1-1000 mug/kg per injection), including saline as a control procedure, were substituted at random for blocks of five consecutive sessions, the frequency of morphine self-administration was found to be an inverted U-shaped function of the injection dose. This relationship was observed in each group of monkeys, despite a 10-fold difference in the total amount of the drug which was available for self-administration per session when a given injection dose was substituted for both groups. The results show that the injection dose of morphine acted as a primary determinant of response probability, even under circumstances in which trial spacing imposed a significant delay between consecutive opportunities for drug self-administration,

Animals↗

Comparison of serum calcitonin levels after a 1-minute calcium injection and after pentagastrin injection in the diagnosis of medullary thyroid carcinoma.

A 1-min calcium injection was compared with a pentagastrin injection as provocative measures in stimulating calcitonin secretion in 4 patients with medullary thyroid carcinoma. In all cases the calcium injection resulted in a greater rise in serum calcitonin concentration. The patients tolerated the calcium injection well. However, two patients experienced substernal pressure and dyspnea following the pentagastrin injection. It is concluded that a 1-min calcium injection is a safe, rapid and effective procedure in the diagnosis of medullary thyroid carcinoma.

Calcitonin↗

Men who have sex with men and also inject drugs-profiles of risk related to the synergy of sex and drug injection behaviors.

OBJECTIVES: Men who have sex with men and also inject drugs (MSM-IDU) are among the groups at highest risk for acquiring and transmitting HIV in Colorado and the US. We conducted formative research and a survey among MSM-IDU in Denver to better understand sexual and drug HIV risk behaviors and how they interact. METHODS: Formative data were collected with 30 persons who work, live or otherwise interact with MSM-IDU using a semi-structured interview instrument. Survey data on sexual and drug risk behaviors were collected with 100 MSM-IDU; eligible participants have had sex with men and injected drugs within the past six months. RESULTS: Results from formative research were used to generate the survey instrument. The survey results demonstrate high-risk sexual behaviors with multiple partners of both genders; 82% of the sample had primary and non-primary male partners, 20% had non-primary female partners, and 15% exchanged money or drugs for sex. Condom use was inconsistent and infrequent for all types of sex (vaginal, anal and oral) and with all types of partners. Drug risk behaviors highlight that the injection drugs of choice for this sample (90% shoot cocaine and 59% shoot methamphetamine) stimulate sexual desire and cocaine injection increases opportunities for injection risk behavior. Forty-five percent of the sample were HIV-infected. Significant differences between HIV infected and non-infected men were not observed with regard to many sexual and drug risk behaviors. CONCLUSIONS: These data show that MSM-IDU are engaging in multiple risk behaviors that may have a synergistic effect on HIV transmission, and that their injection drug of choice contributes to their risk. That there do not appear to be consistent differences in preventive behaviors between men with or without HIV infection suggests a greatly increased risk for HIV transmission in this group of men and their partners. Because MSM-IDU do not identify strongly with either MSM because they may not gay identify or IDU because they do not use heroin, targeted HIV prevention strategies for this group are urgently needed.

Adult↗

Stability of ganciclovir sodium in 5% dextrose injection and in 0.9% sodium chloride injection over 35 days.

The stability of ganciclovir 1 and 5 mg/mL in 5% dextrose injection and in 0.9% sodium chloride injection was studied at 25 degrees C and 5 degrees C over 35 days. Ganciclovir (as the sodium salt) was added to 120 polyvinyl chloride bags containing either 5% dextrose injection or 0.9% sodium chloride injection to attain ganciclovir concentrations of 1 and 5 mg/mL. Thirty bags were prepared for each combination of drug concentration and i.v. solution. Half of the bags in each group were stored at 25 degrees C; the other half were stored at 5 degrees C. Samples withdrawn from all 120 bags immediately after preparation were frozen for later determination of initial concentration. At 7, 14, 21, 28, and 35 days after preparation, approximately 5-mL samples representing each test condition were withdrawn for analysis. The samples were visually examined, tested for pH, and assayed by high-performance liquid chromatography. There was no significant loss of ganciclovir under any of the study conditions over 35 days. All solutions were clear throughout the study period. The pH decreased slightly in both diluents at both ganciclovir concentrations but did not deviate from the manufacturer's range (9-11). Admixtures containing ganciclovir 1 and 5 mg/mL (as the sodium salt) in 5% dextrose injection and 0.9% sodium chloride injection were stable in polyvinyl chloride bags stored at 25 degrees C and 5 degrees C for 35 days.

Chromatography, High Pressure Liquid↗

Comparison of the degree of pulpal anesthesia achieved with the intraosseous injection and infiltration injection using 2% lidocaine with 1:100,000 epinephrine.

This prospective, randomized study compared the degree of pulpal anesthesia obtained from an intraosseous injection to an infiltration injection that used 2% lidocaine with 1:100,000 epinephrine. The success rate for the intraosseous injection was 98%; for the infiltration injection, the success rate was 85%. There was no significant difference between the two techniques. The mean time for the onset of pulpal anesthesia was significantly faster with the intraosseous injection and the infiltration injection resulted in a significantly longer duration of pulpal anesthesia.

Adult↗

Intravesical botulinum type A toxin injection in patients with overactive bladder: Trigone versus trigone-sparing injection.

OBJECTIVE: Botulinum toxin type A (BTX-A) has been successfully used in the treatment of patients with overactive bladder (OAB) symptoms refractory to anticholinergic therapy, with most studies performing trigone-sparing detrusor injections. Increasing evidence suggest that sensory nerve dysfunction contributes to the pathophysiology of OAB and, for this reason, targeting the afferent innervation of the bladder trigone during injection may provide clinical benefit. MATERIALS AND METHODS: We conducted a pilot study to assess the benefit of trigonal-inclusion during BTX-A injection. A total of 40 patients with OAB refractory to anticholinergic treatment received trigone or trigone-sparing injection of BTX-A. Patients were evaluated using UDI-6 and IIQ-7 questionnaires prior to the BTX-A applications, at 3 weeks and 6 months after treatment. RESULTS: At 3-week follow-up, 15/24 (63%) and 10/16 (63%) patients showed improvement of symptoms in the trigone versus trigone-sparing groups, respectively. Combined 3-week UDI-6 and IIQ-7 scores improved from 37.3 prior to treatment to 27.4 (p < 0.05) and 35.5 to 27.2 (p < 0.05) in the trigone and trigone-sparing groups, respectively. Six-month follow-up demonstrated continued but diminished levels of symptom improvement when compared to pre-treatment and 3-week symptom scores. Improvement in symptom scores between the trigone and trigone-sparing groups was not significant. CONCLUSION: No significant difference in symptom score or treatment response was noted between the trigone and trigone-sparing groups. Further study using pre- and post-operative urodynamic study is needed to evaluate possible benefit to trigonal injection in a select sensory urgency cohort, and to assess for urodynamic improvement following trigonal injection.

Administration, Intravesical↗

Stability of zidovudine in 5% dextrose injection and 0.9% sodium chloride injection.

The stability of zidovudine at a concentration of 4 mg/mL in 5% dextrose injection and 0.9% sodium chloride injection in polyvinyl chloride infusion bags stored at room and refrigerated temperatures for up to eight days was studied. Zidovudine was diluted in 5% dextrose injection and in 0.9% sodium chloride injection to a concentration of 4 mg/mL. Six admixtures were prepared with each diluent; three were stored at room temperature (25 +/- 1 degree C) and three were refrigerated (4 +/- 1 degree C). At 0, 3, 6, 24, 48, 72, and 192 hours, 2-mL aliquots were removed. One milliliter of each aliquot was diluted to a zidovudine concentration of approximately 40 micrograms/mL and assayed in duplicate by a stability-indicating high-performance liquid chromatographic method. Visual inspection was performed at each sampling time for precipitation, turbidity, color change, and gas formation. Sample pH was recorded at 0 and 192 hours. In all admixtures, more than 97% of the initial zidovudine concentration remained throughout the study period. No visual or pH changes were observed. Zidovudine 4 mg/mL in admixtures with 5% dextrose injection or 0.9% sodium chloride injection stored in polyvinyl chloride infusion bags was stable for up to 192 hours (eight days) at room temperature and under refrigeration.

Chromatography, High Pressure Liquid↗

Unilateral injection of neuropeptide Y decreases blood flow in the injected testis but may also increase blood flow in the contralateral testis.

Neuropeptide Y (NPY) receptors have recently been described in intratesticular arterioles, but the role of NPY in testicular blood-flow regulation has not been examined. To explore this, we administered NPY in various doses (0.01-10 microg) via intratesticular injections and studied testicular microcirculation using a laser Doppler flow meter. NPY injection shows a dose-response pattern, with 1 microg (the most potent dose) causing a decrease (-42.4 +/- 3.7%, P < 0.00005) in blood flow in the ipsilateral testis of all the animals and an increase in blood flow in the contralateral testis (+17.2 +/- 5.6%, P = 0.03, n = 25 animals). The response in the contralateral testis was variable. A clear-cut increase was seen in 19 of the 25 animals examined, whereas either no response or a slight decrease was seen in the remaining six. The contralateral increase, which was not seen in the hindpaw on the same side, did not occur when the neuronal connections to the testes were blocked by injection of local anesthetics into the spermatic cord, either on the NPY-injected side or on the contralateral side. Our results suggest that NPY may serve as a vasoconstrictor in the testis, probably by acting on the NPY-Y1 receptors present on intratesticular arterioles. Local injection of NPY causes a major decrease in blood flow in the injected testis. This decrease is followed in the majority of animals studied by an increase in blood flow in the contralateral testis, an effect that seems to depend on neuronal mechanisms. This observation suggests that the testes may communicate under certain situations. The functional consequences of this remain to be elucidated.

Animals↗

Percutaneous procedures for the diagnosis and treatment of lower back pain: diskography, facet-joint injection, and epidural injection.

This review discusses the indications, techniques, complications, and results of three percutaneous procedures used to evaluate and treat lower back pain: diskography, facet-joint injection, and epidural injection. Diskography, performed by injection of contrast medium into the nucleus pulposus, is a technique used to determine the cause of lower back pain in patients in whom findings on other imaging studies are normal or conflicting. Injection of steroids and anesthetic into the facet joints of the lumbar spine is useful to diagnose or treat patients with facet syndrome (back pain caused by abnormalities of the facet joints). Injection of steroids and anesthetic agents into the epidural space provides short-term relief, and can sometimes provide permanent relief, of lower back pain.

Anesthesia, Spinal↗

Absorption kinetics of subcutaneously injected insulin. Evidence for degradation at the injection site.

The absorption of subcutaneously injected insulin was examined by injecting semisynthetic [3H] insulin in anaesthetized pigs and subsequently analysing the tissue excised from the injection site. Contrary to previously accepted views, a significant proportion of insulin was degraded at the injection site. The disappearance of intact [3H] insulin from the injection site followed a monoexponential function with a half-time of 59 min.

Absorption↗

Anal submucosal injection: a new route for drug administration in pelvic malignancies. IV. Submucosal anal injection in the treatment of cancer of uterine cervix--preliminary study.

Seven patients with advanced cancer of the uterine cervix were treated by anal submucosal injection of methotrexate. Each course consists of five injections, one every 5 days; each injection contains 100 mg of methotrexate. The course was repeated at 3-week intervals and was given on an outpatient basis. Investigations were performed before, during, and after treatment. Methotrexate blood level was measured 4 and 24 hours after administration. Complete response occurred in all seven patients. Relapse occurred in four but could be controlled by further methotrexate administration. Average duration of survival is 46 1/2 months. No side effects were encountered as a result of a low methotrexate serum level that was recorded 4 hours after administration, 0.82 mumol after anal injection compared with 2.8 mumol for the intravenous route. The beneficial effect seems to be the result of the high methotrexate concentration in uterine and tumor tissue. The route adopted by the drug to reach the uterus from the anal submucosa is through the hemorrhoidogenital communicating veins. This preliminary study demonstrates that anal injection of methotrexate is effective in the treatment of advanced cancer. It is safe, well tolerated, and can be used as an outpatient treatment.

Aged↗

Periodontal ligament injection: distribution of injected solutions.

In a simulation of the clinical technique, a radiopaque solution and a colloidal carbon suspension were injected into the periodontal ligament in dogs by means of a standard syringe. The colloidal carbon method was superior and demonstrated that the injected material was found in soft tissue and adjacent hard structures and in the vessels of the pulps of the immediate and adjacent teeth. The distribution of the dye did not relate to the injection volume and needle location but was consistently more widespread when injections were given under moderate to strong pressure. The technique appears to be a form of intraosseous injection.

Anesthesia, Dental↗

Vasopressin pressor antagonist injected centrally reverses behavioral effects of peripheral injection of vasopressin, but only at doses that reverse increase in blood pressure.

Previous work in rats (Ader, R. and De Wied, D., Psychon. Sci., 29 (1972) 46-48) has established that subcutaneously (s.c.) injected arginine vasopressin (AVP) prolongs extinction of active avoidance and that this effect could be prevented by pretreatment with the vasopressin antagonist analog [1-deaminopenicillamine, 2-(O-methyl)tyrosine]-beta-arginine vasopressin (dPtyr(Me)AVP). The purpose of the present study was to determine if peripherally administered AVP acts via a peripheral blood pressure effect or by a direct action in the central nervous system. We therefore tested the effects of the antagonist injected intracerebroventricularly (i.c.v.) on the prolongation of active avoidance and on blood pressure effects of s.c. injected AVP. The antagonist (i.c.v.) blocked the behavioral effects of systemically injected AVP only at dose sufficient to block the peripherally mediated pressor response of systemically administered AVP. The results show that peripherally injected AVP acts on peripheral systems and support our hypothesis that the peripheral visceral action of AVP contributed significantly to its behavioral action.

Animals↗

[Analgesic effects of Emla cream and saccharose solution for subcutaneous injections in preterm newborns: a prospective study of 265 injections].

OBJECTIVE: To compare the analgesic effects of non nutritive pacifier sucking, oral administration of a 30% saccharose solution, local application of Emla and their association for subcutaneous injection of erythropoietin (EPO) in preterm infants. METHODS: Our study was a randomised, prospective study conducted over 5 months. Neonates with a gestational age below 33 weeks of gestation and older than 8 days of life were included if they were treated with EPO (three subcutaneous injections per week during 6 weeks). For each consecutive EPO injection, patients were randomised between four groups of intervention: non nutritive pacifier sucking (T), oral administration of 0.2-0.5 ml of a 30% saccharose solution with non nutritive pacifier sucking (S), local application of Emla with non nutritive pacifier sucking (E), and oral administration of 0.2-0.5 ml of a 30% saccharose solution with local application of Emla and with non nutritive pacifier sucking (S + E). Each child was its own control. Pain was assessed with the Newborn Acute Pain scale (DAN) and with the Neonatal Facial Coding System (NFCS). RESULTS: Thirty-three neonates were included, representing 265 injections. Distribution was: 41 in group T, 71 in group E, 86 in group S and 67 in group E + S. Mean DAN and NFCS scores were statistically different between groups T, E and S. Analgesic effect of saccharose (-1.05) was greater than Emla (-0.56). Used together, effects were adding up without potentialisation. CONCLUSION: This study shows that the association of non nutritive pacifier sucking with oral administration of saccharose and local application of Emla has a better analgesic effect than each of these three interventions alone for subcutaneous injection of EPO.

Administration, Cutaneous↗

Effects of the hypo-osmotic swelling test on the outcome of intracytoplasmic sperm injection for patients with only nonmotile spermatozoa available for injection: a prospective randomized trial.

OBJECTIVE: Hypo-osmotic swelling test (HOST) has been shown to be an effective method for the selection of live sperm. On-going pregnancies were obtained by using HOST-selected sperm. The aim of this study was to evaluate the effect of using HOST-selected "live" sperm versus nonselected sperm on the outcome of intracytoplasmic sperm injection cycles when only nonmotile sperm were available for injection. DESIGN: Prospective randomized study. SETTING: Governmental tertiary care hospital. PATIENT(S): Thirty ICSI cycles with no motile sperm were included in this study. INTERVENTION(S): For the HOST group, potentially live spermatozoa detected by hypo-osmotic reaction of the tail were injected into oocytes. For the No-HOST group, the sperm were randomly injected into the oocytes without checking the viability. MAIN OUTCOME MEASURE(S): The fertilization, cleavage, embryo quality, pregnancy, and implantation rates were assessed for the two groups. RESULT(S): Among 30 cycles, 15 fall into each group. Fertilization, cleavage rates, and the number of good quality embryos were similar between two groups. CONCLUSION(S): HOST-selected live spermatozoa can be safely used for intracytoplasmic sperm injection to establish pregnancies. There is a tendency for higher pregnancy and implantation rates to result, but it does not reach statistical significance.

Embryo Implantation↗

A control, double-blind comparison of mepivacaine injection versus saline injection for myofascial pain.

In a double-blind study 28 patients with acute, localised muscle pain received four local injections of mepivacaine 0.5%, and 25 patients with the same type of pain received local injections of an equivalent volume of physiological saline. The group receiving saline tended to have more relief of pain, especially after the first injection. The results thus show that pain relief is not due merely to the local anaesthetic. The study therefore raises questions about the mechanism by which local injections into muscle relieves pain, since there is the possibility that a similar effect might also be achieved by merely inserting a needle into the trigger point. Physiological saline is considered to be a more appropriate fluid for injection therapy than local anaesthetics since it is less likely to produce side-effects.

Clinical Trials as Topic↗

Intrathecal injection: unusual complication of trigger-point injection therapy.

Trigger-point injection therapy is a common procedure in primary care medicine and emergency medicine and is generally considered safe. A 28-year-old woman experienced respiratory depression and hemiplegia after the injection of a superficial trapezius trigger point. The patient required emergency tracheal intubation for ventilatory support. Computed tomography of her head revealed pneumocephalus. She recovered fully over the course of 24 hours. Intrathecal injection during a trigger-point injection is a previously unreported complication of trigger-point injection therapy.

Administration, Topical↗

Development of solid-phase chemiluminescence immunoassays for digoxin comparing flow injection and sequential injection techniques.

The development of a competitive solid-phase immunoassay for digoxin making use of the acridinium chemiluminescence system is described. Two different instrumental approaches are compared. One is based on a continuous flow system using a peristaltic flow injection analysis pump; the other uses a new sequential injection technique. In both systems a flow cell, consisting of transparent PTFE tubing packed with immobilized antibodies, acts as an immunoreactor. The entire assay, including both the immunoreaction and the chemiluminescence reaction, takes place in this immunoreactor cell. Compared with the flow injection technique, the sequential injection mode showed higher precision, ranging from 2.16 to 5.5% RSD depending on concentration. The total assay time, including regeneration, is less than 8 min with the sequential injection technique. The detection limit for both techniques is in the low femtomole range.

Cardiotonic Agents↗