Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Injectables”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 991 records · Page 55Linked to original sources
PubMed2005

Combination injectable contraceptives for contraception.

BACKGROUND: Combination injectable contraceptives provide a highly effective, reversible method of preventing pregnancy, and they do not require daily administration or use at the time of coitus. Although they are used in many countries, their acceptability could be limited by method characteristics, such as the need to obtain a monthly injection or bleeding pattern changes. OBJECTIVES: To assess the contraceptive efficacy, bleeding patterns, discontinuation, user preferences, and side effects of combination injectable contraceptives. SEARCH STRATEGY: We searched computerized databases for randomized controlled trials of combination injectable contraceptives. SELECTION CRITERIA: Randomized controlled trials reported in any language were eligible if they compared a combination injectable with any other contraceptive method (e.g., a second combination injectable contraceptive, progestin-only injectable contraceptive, other hormonal contraceptive or barrier method) or placebo. We limited the review to currently marketed combination injectable contraceptives. DATA COLLECTION AND ANALYSIS: The primary reviewer evaluated all titles and abstracts from the literature searches to determine their eligibility. Two reviewers independently extracted data from the eligible trials. Data on contraceptive efficacy, bleeding patterns, continuation, and side effects were entered and analyzed with RevMan 4.2. MAIN RESULTS: Combination injectable contraceptives include depot medroxyprogesterone acetate (DMPA) 25 mg plus estradiol cypionate (E(2)C) 5 mg, as well as norethisterone enanthate (NET-EN) 50 mg plus estradiol valerate (E(2)V) 5 mg. These combination injectable contraceptives resulted in lower rates of early study discontinuation due to amenorrhea or other bleeding problems, but had higher rates of discontinuation due to other reasons than the progestin-only comparison contraceptives. Studies comparing two combination injectable contraceptives found that NET-EN 50 mg plus E(2)V 5 mg resulted in less overall early discontinuation and less discontinuation due to amenorrhea or prolonged bleeding than DMPA 25 mg plus E(2)C 5 mg. However, these differences were not detected in all trials making this comparison. The NET-EN plus E(2)V group also had more cyclical (regular) bleeding and fewer prolonged bleeding reference periods than the DMPA plus E(2)C group. The groups did not differ in their amenorrhea rates. AUTHORS' CONCLUSIONS: While discontinuation rates can be viewed as a measure of method acceptability, the findings should be interpreted with caution since discontinuation rates are dependent on many other factors. Future research should be directed toward interventions to improve the acceptability of combination injectable contraceptives, such as providing injections in settings more convenient than clinical sites, methods for women to administer their own injections, and counseling about possible bleeding pattern changes.

Algestone↗
PubMed1991

Induction of proliferating cell nuclear antigen (PCNA)-immunoreactive cells in goldfish retina following intravitreal injection with 6-hydroxydopamine.

1. The dopaminergic neurotoxin, 6-hydroxydopamine (6-OHDA), was injected intravitreally into the eyes of juvenile (5- to 6-cm) goldfish. 2. Proliferation of rod neuroblasts caused by 6-OHDA (2 micrograms in 2 microliters saline) was detected in retinal wholemounts by immunofluorescence for proliferating cell nuclear antigen (PCNA) 3, 7, 14, 20, or 30 days after injection. 3. The injected dose of 6-OHDA was sufficient to cause permanent loss of dopaminergic interplexiform and serotonergic amacrine cells in the injected eye but not in the contralateral control eye. 4. 6-OHDA increased the density (mm-2) of PCNA-ir cells in the outer nuclear layer (ONL) of the injected eye to 2.65 times the initial density 20-30 days after injection, and it increased the density of PCNA-ir cells in the ONL of the contralateral, untreated eye, equally but after a delay of less than or equal to 7 days with respect to the injected eye. 5. 6-OHDA also increased the density of PCNA-ir cells in the inner nuclear layer (INL) to greater than 20 times the initial density 7 days after injection, followed by a rapid decline almost to control levels by 14 days after injection. 6. The sequence of responses to 6-OHDA, with PCNA-ir cells first scattered in the ONL and then clustered in the INL, suggests that neuroblasts from the ONL migrate to the INL to compensate for toxin-induced cell loss. 7. Double staining for 5-bromodeoxyuridine (BrUdR; a thymidine analogue) and PCNA, carried out on 7 days after intravitreal injection with 6-OHDA, showed that 77% of all PCNA-ir cells in the outer nuclear layer had been in S phase during the previous 24 hr. 8. Immunoreactivity for PCNA was found to be a valid marker for rod neuroblasts which have entered S phase within 1-2 days before sampling and was shown to be especially convenient for investigating the distribution of proliferating cells in whole mounts. 9. In controls injected unilaterally with saline or saline plus 1% dimethyl sulfoxide (DMSO), the differences in densities of PCNA-ir rod precursor nuclei 2-30 days after injection vs. day 0 (uninjected) were statistically insignificant in both injected and uninjected eyes (Negishi et al., 1991). Therefore the local effect of injecting 6-OHDA was due to 6-OHDA itself, not to mechanical damage or nonspecific actions of foreign substances.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1997

Fever and production of cytokines in response to repeated injections of muramyl dipeptide in guinea-pigs.

Fever and systemic plasma levels of the cytokines tumour necrosis factor alpha (TNF) and interleukin-6 (IL-6) were measured in guinea-pigs in response to single or repeated intramuscular injections of 100 micrograms/kg muramyl-dipeptide (MDP). In a pilot study (experiment 1), MDP-induced fever was monitored for 8 h. The first fever phase 90-360 min after injection of MDP was followed by the second phase which continued beyond the duration of this experiment. High circulating levels of TNF and IL-6 were detected just before body core temperature started to rise. Within the next 90 min TNF declined again by more than 90% while IL-6 remained elevated. In experiment 2, the effects of repeated injections of MDP (5 times at intervals of 3 days) on the same parameters were investigated. In this paradigm, the febrile response started earlier (60 min after injection) and the first phase of fever remained manifest until 360 min after injection, while the late phase, measured 360-720 min after injection, was attenuated. Circulating, bioactive TNF and IL-6, measured 60 and 180 min after MDP was administered, were the same in response to the first, third, and fifth injection. In experiment 3, the influence of five repeated MDP injections on the abdominal temperature was measured for 22 h, and circulating cytokines were analysed before (360 min after injection) and during (480 min after injection) the late phase of MDP-induced fever. The late phase of MDP-induced fever 7-22 h after injection was attenuated in response to the second and further administrations of this pyrogen. At 6 h after the first, third, and fifth administration of MDP, only traces of TNF alpha were measured, 2 h later no bioactive TNF was detected at all. At these times also IL-6 declined again, compared with the activity of this cytokine measured during the early phase of MDP fever, but was still present in elevated amounts. Compared with the values measured in response to the third and fifth injections of MDP, circulating IL-6 was higher 360 min and 480 min after the first injection. It remains speculative whether the longer duration of elevated IL-6 in plasma is related to the development of the long-lasting, late phase of MDP-induced fever, which was only observed after the first of five repeated injections of MDP at intervals of 3 days.

Abdomen↗
PubMedDate not supplied

Unnecessary injections and paralytic poliomyelitis in India.

The effect of prior injections on the pattern and severity of paralytic poliomyelitis has been examined by a retrospective analysis of case notes from an outpatient pediatric clinic in South India. Of 262 children with acute polio, 176 had received unnecessary injections < 48 h before paralysis and 12 had received diphtheria-pertussis-tetanus or provocative injections. Two children injected in the right arm had paralysis in that limb only. Children with no injections (controls) had an equal chance of paralysis (0.73) in each left and right leg. Children with injections in the right or left gluteus or in both had a 19% greater chance of paralysis in the injected leg(s), whereas uninjected legs had a 31% lower chance of paralysis. Injected leg muscles were weaker than those of control children. Legs of control children were stronger than those with one leg injected and much stronger than those with both injected. More than 96% of the children had at least one leg paralysed. Age and vaccine status did not affect the results of injections. After injections there was greater likelihood of death or lack of recovery of muscle strength. About three-quarters of the children had received unnecessary injections; of these 60% had more severe paralysis and a non-paralytic attack became paralytic in 40%. If oral medicines for fevers and diarrhoea replaced unnecessary injections, the prevalence and severity of paralytic polio would be reduced.

Arm↗
PubMed2005

The number of injections does not influence absorption of bupivacaine after cervical plexus block for carotid endarterectomy.

STUDY OBJECTIVE: To investigate the efficacy and kinetics of bupivacaine when used for deep cervical plexus block (CPB), using either a single-injection or multiple-injections technique. DESIGN: Prospective, randomized, double-blind study. SETTING: Operating room of a university hospital. PATIENTS: Twenty-four adult patients (16 men, 8 women) scheduled for carotid endarterectomy. INTERVENTIONS: Patients were randomly assigned to receive CPB either by a single injection or after 3 injections. Patients in the multiple-injections group received a total dose of 15 mL of 0.5% bupivacaine (5 mL each deposited at C2, C3, and C4 over 2 minutes). Patients in the single-injection group received a single 15-mL injection of 0.5% bupivacaine. After the deep CPB, a superficial CPB was performed with 20 mL of 0.5% bupivacaine in all patients. MEASUREMENTS: An anesthesiologist and a surgeon graded the success of the block. Arterial plasma concentrations of bupivacaine were measured using liquid chromatography-mass spectroscopy. MAIN RESULTS: No significant differences were seen between the 2 groups with respect to the mean peak concentration of bupivacaine (single injection 2314 +/- 1385 ng/mL vs multiple injections 2255 +/- 1105 ng/mL) or time to reach the maximal concentration (time to maximum concentration [single injection 12.1 +/- 7.2 minutes vs multiple injections 12.5 +/- 3.9 minutes]). Furthermore, there were no significant differences in mean block scores between the single-injection and the multiple-injections groups, evaluated either by the anesthesiologists or the surgeon. CONCLUSIONS: The results of this study showed that the absorption of bupivacaine is independent of the number of injections after CPB, and that anesthesia for carotid endarterectomy may be accomplished successfully using either technique.

Absorption↗
PubMed1997

Effect of deep injections of local anesthetics and basal dilatation of cervix in management of pain during legal abortions. A randomized, controlled study.

The present study was designed to investigate whether deep injections of local anesthetics provide better pain control than regular injections of local anesthetics, and to evaluate the influence of basal cervical dilatation and dilatation increase obtained on the painfulness of abortion procedure during legal abortions. A total of 66 women undergoing legal abortion were randomly allocated to treatment with deep injection (n = 31) or regular injection (n = 35) group. Subjects in the deep injection group had paracervical block involving four injections approximately 3 cm deep. Subjects assigned to the regular injection group had paracervical block involving four injections approximately 1.5 cm deep. A pain scale was administered at the end of the dilatation and end of curettage. Both groups were found to be similar with respect to age, parity, previous legal abortion, gestational age, anxiety score, procedure time, basal cervical dilatation, and dilatation increase obtained. The mean pain score during cervical dilatation was less for the deep injection versus the regular injection group (3.3 +/- 1.5 versus 4.0 +/- 1.6, p < 0.05). The mean pain score during curettage was significantly less for the deep injection versus the regular injection group (3.0 +/- 1.2 versus 3.9 +/- 1.4, p < 0.05). In conclusion, deep injection of local anesthetics is a safe adjunct in the management of legal abortion. Irrespective of injection technique, dilatation pain is correlated negatively with basal cervical dilatation and correlated positively with dilatation increase obtained.

Abortion, Legal↗
PubMed2002

Effects of NMDA and non-NMDA ionotropic glutamate receptor antagonists on the development and maintenance of hyperalgesia induced by repeated intramuscular injection of acidic saline.

Two unilateral injections of pH 4.0 saline into the gastrocnemius muscle result in a bilateral decrease in mechanical withdrawal threshold after the second injection. This decrease is significant by 4h and lasts through 1 week. The purpose of this study was to characterize the involvement of both N-methyl-D-aspartate (NMDA) and non-NMDA glutamate receptors in the spinal cord dorsal horn in the development and maintenance of mechanical hyperalgesia from repeated intramuscular injections of acidic saline. 2-amino-5-phosphonovaleric acid (AP5) (2-20 nmol, 10 microl, pH 7) or 1,2,3,4-tetrahydro-6-nitro-2,3-dioxo[f]quinoxaline-7-sulfonamide (NBQX) (1-10 nmol, 10 microl, pH 8-9) was administered intrathecally to the lumbar spinal cord to block NMDA and non-NMDA ionotropic glutamate receptors in the dorsal horn, respectively. Drugs were administered at one of three different time points: (1) prior to the first intramuscular injection of pH 4.0 saline on Day 0, (2) prior to the second intramuscular injection of pH 4.0 saline on Day 5, and (3) 1 week after the second injection. Mechanical withdrawal thresholds were measured with von Frey filaments before, 4h, and 24h after injection 1 and before, 4h, 24h, and 1 week after injection 2. AP5 had no effect on mechanical withdrawal thresholds when administered prior to the first intramuscular injection of pH 4.0 saline. When AP5 was administered before the second intramuscular injection, the bilateral decrease in mechanical withdrawal thresholds was delayed for up to 24h. Intrathecal administration of AP5 1 week after the second intramuscular injection of pH 4.0 saline produced a bilateral increase in mechanical withdrawal thresholds. Blockade of non-NMDA glutamate receptors in the spinal cord dorsal horn prior to either the first or second intramuscular injection of pH 4.0 saline had no effect on the development of mechanical hyperalgesia. However, spinal injection of NBQX 1 week after the second intramuscular injection of pH 4.0 saline resulted in an increase in mechanical withdrawal thresholds when compared to vehicle controls. These data suggest that both NMDA and non-NMDA glutamate receptors are involved in the maintenance of chronic, muscle-induced hyperalgesia.

2-Amino-5-phosphonovalerate↗
PubMed2002

Unilateral versus bilateral injections of botulinum toxin in patients with adductor spasmodic dysphonia.

Both unilateral and bilateral thyroarytenoid muscle injections of Botox provide effective management of voice symptoms in patients with adductor spasmodic dysphonia; however, the preferred injection technique has not been established. In this study, 16 patients were treated with unilateral injections (72 injections total) and 33 patients were managed with bilateral injections (133 injections total). Individual assignments to injection type were based on treatment previously received and dose was adjusted according to the patient's previous treatment response. An optimal treatment included a benefit lasting 3 months or more with side effects lasting 2 weeks or less. Compared to patients receiving bilateral injections, those receiving unilateral injections more frequently noted a benefit of 3 months or more (p = 0.03), side effects of 2 weeks or less duration (p = 0.03), as well as both a 3-month benefit and a 2-week or less side effect (p = 0.0004). Injection type had no effect on optimal Botox dosing with repeat injections. Successive unilateral injections at the same dose were more likely (p = 0.012) than successive bilateral injections to produce the same or longer duration of benefit. We conclude that a unilateral injection routine has a more optimal and consistent treatment effect/side effect profile.

Adult↗
PubMed2002

Comparison of effects of lidocaine hydrochloride, buffered lidocaine, diphenhydramine, and normal saline after intradermal injection.

STUDY OBJECTIVE: To evaluate pain and the spread of analgesia when local anesthetics are given as an intradermal injection into the dorsal aspect of the hand. DESIGN: Randomized, double-blinded, placebo-controlled study. SETTING: University medical center. PATIENTS: 40 consenting adult volunteers. INTERVENTIONS: Volunteers were randomly assigned to receive a 0.25-mL injection of either lidocaine hydrochloride (1%), buffered lidocaine, diphenhydramine (1%), or placebo (0.9% sodium chloride solution) into the dorsal aspect of both hands. MEASUREMENTS: The volunteers used a visual analog scale to compare the pain of needle insertion and solution injection. Then at 1, 2, 5, 10, 20, and 30 minutes after intradermal injection, the extent of the analgesic area was marked on a strip of tape placed horizontally across the hand. Then at 32 minutes after intradermal injection, the extent of the analgesic area was marked on a strip of tape placed vertically across the hand. The volunteers were called each day and asked the duration of their numbness or hyperesthesia until their hands were no longer numb or sore. MAIN RESULTS: Buffered lidocaine during intradermal infiltration was found to be significantly (p < 0.05) less painful than either lidocaine hydrochloride or diphenhydramine and equivalent to placebo. Diphenhydramine and lidocaine hydrochloride during intradermal infiltration induced significantly (p < 0.05) more pain than buffered lidocaine or placebo. Lidocaine hydrochloride displayed a significantly (p < 0.05) larger diameter of analgesia than placebo by 1 minute after the injection, buffered lidocaine by 2 minutes after injection, and diphenhydramine by 5 minutes after injection. By 20 minutes after injection, diphenhydramine diameter of analgesia was significantly (p < 0.05) larger than placebo but significantly less than buffered lidocaine. By 30 minutes after injection, diphenhydramine diameter of analgesia was equivalent to placebo whereas buffered lidocaine and lidocaine diameters were still significantly (p < 0.05) larger than placebo. Diphenhydramine injection resulted in numbness that lasted significantly (p < 0.05) longer than other study solutions whereas buffered lidocaine and lidocaine injections resulted in numbness that lasted significantly longer than placebo. Diphenhydramine injection resulted in hyperesthesia that lasted for 2 or more days in 12 of the volunteers. CONCLUSION: There is a reduction of infiltration pain using buffered lidocaine as opposed to lidocaine and diphenhydramine. Although lidocaine injection resulted in a slightly faster spread of analgesic diameter, buffered lidocaine was equivalent to lidocaine from minute 2 until minute 30. Therefore, to obtain optimal anesthetic conditions, we recommend that buffered lidocaine be given 2 minutes before performing catheterization, whereas diphenhydramine should be given 5 minutes before catheterization, but only when buffered lidocaine cannot be used.

Adult↗
PubMed2000

Preoperative lymphoscintigraphy during lymphatic mapping for breast cancer: improved sentinel node imaging using subareolar injection of technetium 99m sulfur colloid.

BACKGROUND: Preoperative lymphoscintigraphy has been recommended to confirm the successful uptake and direction of migration of radiotracer into sentinel nodes during lymphatic mapping for breast cancer. In addition, preoperative lymphatic mapping may provide a visually useful aid to the relative location of sentinel nodes within a nodal basin. One common method of breast lymphoscintigraphy involves injections of unfiltered technetium 99m sulfur colloid (Tc-99m-SC) directly into parenchymal tissues surrounding a tumor or biopsy cavity (IP injection). Because of the many imaging failures and prolonged imaging times of IP lymphoscintigraphy, the procedure has fallen into disfavor by oncologic surgeons. The purpose of this study is to document the increased success rate of preoperative breast lymphoscintigraphy using a new anatomic site of injection, the subareolar lymphatic plexus (SA injection). STUDY DESIGN: In the 12 months between December 1, 1998, and December 29, 1999, 42 women with stage I and II breast cancer underwent preoperative lymphoscintigraphy by either the IP (n = 12, December 1998 to May 1999) or SA (n = 30, May 1999 to December 1999) route of injection. Both groups were injected with 1 mCi (37 MBq) of unfiltered Tc-99m-SC followed immediately by external gamma-camera imaging. The success rate for preoperative sentinel node imaging and the total imaging time were recorded in both groups. RESULTS: The success rate of identifying a sentinel node by SA lymphoscintigraphy was 90% (n = 27 of 30 patients), compared with 50% (n = 6 of 12 patients) for IP lymphoscintigraphy (p = 0.009). The imaging time in the SA injection group was 34 +/- 16 minutes, which was 59% shorter than the imaging time in the IP injection group of 82 +/- 48 minutes (p < 0.001). No uptake into internal mammary nodes was seen in either group. CONCLUSIONS: Moving the site of injection ofunfiltered Tc-99m-SC to the subareolar lymphatic plexus (SA injection) increased the success rate of preoperative lymphoscintigraphy to 90%, compared with 50% using IP injections. Preoperative SA lymphoscintigraphy resulted in the rapid visualization of axillary sentinel nodes within 30 minutes of SA injection, enabling a visual determination of the approximate number of sentinel nodes and their relative locations within the axilla. We conclude SA injection of unfiltered Tc-99m-SC is superior to IP injections when performing preoperative breast lymphoscintigraphy and is a visually useful aid to lymphatic mapping for breast cancer.

Adult↗
PubMed2001

Therapeutic injections in Pakistan: from the patients' perspective.

OBJECTIVE: To investigate the behaviour, knowledge of risks, and attitudes towards injections among patients at a clinic in Karachi. METHODS: In March 1995, trained staff administered a structured questionnaire to 198 consecutive new adult patients attending a university clinic in Karachi, Pakistan. RESULTS: Half (97:49%) of the patients received injections at their last visit to a health care provider. 3.5% had received 10 or more injections in the last year. 64% felt that injections were more powerful and were willing to pay more for them than for pills. 84% preferred pills or advice over injections if told they were equally effective, 83% believed that a used needle could transmit a fatal disease, and 86% believed that it is usually possible to get better without an injection. 91% reported that the doctor always recommends an injection; few patients (9%) ever asked for one. Injections were given without much regard for the chief complaint of the patient. Sonic needles (n = 21) for the injection came from bowls of water: of those from closed packets (n = 116), 68 were 'cleaned' by wiping ot placing them in water. 91% of patients (180) knew at least one risk of reuse of needles. Patients who knew three or more risks of using unclean needles were 0.14 times as likely to have had more than five injections per year in the last 5 years hut only if the patients had s or more years of education. CONCLUSION: Patients receive injections from doctors in Pakistan frequently, indiscriminately and often without proper safety precautions. They are aware of both positive and negative aspects of injections but are likely to do what the doctor suggests. Interventions to reduce risky overuse of injections should focus on patients' general education and knowledge of the risks of injections to empower them to choose healthier therapies.

Adult↗
PubMed2003

Overview of injection practices in two governorates in Egypt.

OBJECTIVE: To describe the extent and characteristics of injection use and injection providers in Egypt, given that unsafe injections are associated with blood-borne pathogen transmission. METHODS: Household surveys of a population-based sample of residents in the Nile Delta and in Upper Egypt; focus group discussions and in-depth interviews with community target groups, formal and informal medical providers. RESULTS: Of 4197 persons interviewed, 26.2% reported receiving an injection in the past 3 months. Of these, 77% reported it was for therapeutic indications. The age-sex specific prevalence of injections was highest among children 0-2 years of age and among older adults. Women were more likely to report having an injection than men, particularly at the age above 20 years. Overall, respondents reported receiving on average 4.2 injections per year, indicating that up to 281 million injections are provided per year in Egypt. Injection administrators were public and private sector physicians, pharmacists, barbers, doctor assistants, housekeepers, relatives and friends. Injection prescribers were mostly private and public sector physicians. Of the 1101 respondents who received an injection in the past 3 months, 92 (8.4%) reported that the provider did not use a syringe taken from a closed sealed packet. CONCLUSION: The frequency of therapeutic injection use is high in Egypt and may contribute to blood-borne pathogen transmission. The Ministry of Health and Population (MOHP) is developing interventions targeted towards promotion of injection safety and reduction of injection overuse on community basis as part of a comprehensive strategy to prevent blood-borne pathogen transmission in Egypt.

Adolescent↗
PubMedDate not supplied

Pain on intramuscular injection of bupivacaine, ropivacaine, with and without dexamethasone.

BACKGROUND AND OBJECTIVES: We wished to determine which long-acting local anesthetic would produce the least pain on injection for treatment of myofascial pain disorders. We compared the pain on intramuscular injection of bupivacaine, ropivacaine, bupivacaine with dexamethasone, ropivacaine with dexamethasone, and needle placement alone. METHODS: Thirty volunteers received 5 injections each: (1) needle only, (2) bupivacaine 0.5%, (3) ropivacaine 0.5%, (4) bupivacaine 0.5% with dexamethasone 0.13 mg/mL, and (5) ropivacaine 0.5% with dexamethasone 0.13 mg/mL. The injections were made in the volunteers' upper trapezius muscles; there was a 15-minute interval between injections. The sequence of injections was randomized by Latin square design. The intensity of pain was rated on a 0 to 10 cm visual analogue scale (VAS) score. Neither the investigator nor the volunteer was aware of the nature of the injectate. The pH of the injected solutions was checked to determine if differences in the intensity of pain on injection were due to differences in the pH of the solutions. RESULTS: The VAS pain scores were 3.1 +/- 2.4 for needle only, 4.4 +/- 2.8 for bupivacaine, 2.5 +/- 2.0 for ropivacaine, 4.7 +/- 2.7 for bupivacaine/dexamethasone, and 3.7 +/- 2.2 for ropivacaine/dexamethasone. The pain on injection of ropivacaine was significantly less than the pain on injection of bupivacaine or bupivacaine/dexamethasone. The pH values of the solutions were as follows: (1) bupivacaine, 5.50; (2) ropivacaine, 5.57; (3) bupivacaine/dexamethasone, 6.64; and (4) ropivacaine/dexamethasone, 6.60. CONCLUSIONS: The pain on intramuscular injection of bupivacaine is significantly more intense than with ropivacaine. The difference in the intensity of the pain on injection between bupivacaine and ropivacaine does not appear to be related to differences in pH. The results of our study have implications on the choice of the local anesthetic used in trigger point injections.

Adult↗
PubMed1995

Intramuscular injections within 30 days of immunization with oral poliovirus vaccine--a risk factor for vaccine-associated paralytic poliomyelitis.

BACKGROUND: In Romania the rate of vaccine-associated paralytic poliomyelitis is for unexplained reasons 5 to 17 times higher than in other countries. Long ago it was noted that intramuscular injections administered during the incubation period of wild-type poliovirus infection increased the risk of paralytic disease (a phenomenon known as "provocation" poliomyelitis). We conducted a case-control study to explore the association between intramuscular injections and vaccine-associated poliomyelitis in Romania. METHODS: The patients were 31 young children in whom vaccine-associated paralytic poliomyelitis developed from 1988 through 1992. Eighteen were vaccine recipients, and 13 had acquired the disease by contact with vaccine recipients. Each of these children was matched with up to five controls according to health center, age, and in the case of vaccine recipients, history of receipt of the live attenuated oral poliovirus vaccine. Data were abstracted from medical records that documented the injections administered in the 30 days before the onset of paralysis. RESULTS: Of the 31 children with vaccine-associated disease, 27 (87 percent) had received one or more intramuscular injections within 30 days before the onset of paralysis, as compared with 77 of the 151 controls (51 percent) (matched odds ratio, 31.2; 95 percent confidence interval, 4.0 to 244.2). Nearly all the intramuscular injections were of antibiotics, and the association was strongest for the patients who received 10 or more injections (matched odds ratio for > or = 10 injections as compared with no injections, 182.1; 95 percent confidence interval, 15.2 to 2186.4). The risk of paralytic disease was strongly associated with injections given after the oral polio virus vaccine, but not with injections given before or at the same time as the vaccine (matched odds ratio, 56.7; 95 percent confidence interval, 8.9 to infinity). The attributable risk in the population for intramuscular injections given in the 30 days before the onset of paralysis was 86 percent (95 percent confidence interval, 66 to 95 percent); that is, we estimate that 86 percent of the cases of vaccine-associated paralytic poliomyelitis in this population might have been prevented by the elimination of intramuscular injections within 30 days after exposure to oral poliovirus vaccine. CONCLUSIONS: Provocation paralysis, previously described only for wild-type poliovirus infection, may rarely occur in a child who receives multiple intramuscular injections shortly after exposure to oral poliovirus vaccine, either as a vaccine recipient or through contact with a recent recipient. This phenomenon may explain the high rate of vaccine-associated paralytic poliomyelitis in Romania, where the use of intramuscular injections of antibiotics in infants with febrile illness is common.

Anti-Bacterial Agents↗
PubMed2003

Treatment of postoperative male urinary incontinence using transurethral macroplastique injections.

PURPOSE: To study the effect of Macroplastique injection on postoperative stress urinary incontinence (SUI) in male patients. PATIENTS AND METHODS: Since 1997, 50 consecutive men with a mean age of 66.0 years (range 51-75 years) suffering from mild to moderate postoperative SUI were treated as outpatients with transurethral Macroplastique injections. Under local anesthesia, 2.5 to 5 mL of Macroplastique was injected adjacent to the external sphincter at 5 or 7 o'clock or both. Forty-six patients had undergone radical prostatectomy, three transurethral prostatic resection, and one cystoprostatectomy with bladder substitution. Patients suffering from detrusor instability were excluded. A standardized 1-hour pad test and the patient's grading of the severity of the incontinence from 0 to 3, where 0 meant leaking took place all the time and 3 that the patient was completely dry, were carried out prior to injection and again at 3 months after each injection. Macroplastique injection was repeated if the initial treatment was not curative. RESULTS: The mean 1-hour pad test loss was 48.3 mL at baseline. After the first injection, 6 patients were completely dry and 28 improved; in the rest, no improvement was achieved. Forty patients underwent a second injection after which, 10 more patients became completely dry and 5 improved significantly. Twenty-three patients underwent a third injection, after which, 9 more patients were completely dry. Fourth injections were given to 8 patients, of whom 5 became dry, 1 improved, and 2 patients did not get any benefit. The total volume of Macroplastique injected ranged from 2.5 to 13.5 mL (mean 7.1 mL). A majority of the patients suffered some dysuria following the injection, but there were no significant side effects. CONCLUSIONS: The preliminary results of endoscopic treatment of mild to moderate postoperative SUI in males with outpatient Macroplastique injections are encouraging. To achieve satisfactory results, repeated injections are needed.

Aged↗
PubMed1993

Repeated intracoronary injections of contrast media. Additive hemodynamic and electrophysiologic effects in a dog model.

RATIONALE AND OBJECTIVES: Coronary arteriography in patients implies several selective injections into the coronary arteries. The authors investigate whether repeated injections cause additive cardiac hemodynamic and electrophysiologic effects in dogs. METHODS: Five repeated injections of 5 mL iohexol (Omnipaque 350 mgI/mL, Nycomed Imaging AS, Oslo, Norway), ioxaglate (Hexabrix 320 mgI/mL, Laboratory Guerbet, Cedex, France), and sodium meglumine-diatrizoate (Renografin-76 370 mgI/mL, Squibb Diagnostics, Princeton, NJ) were given into the left coronary artery in 7 anesthetized dogs and were compared with the effects after a 5 mL single injection of the same medium. Left ventricular (LV) pressures, LV dP/dtmax (inotropy) and epicardial monophasic action potential were recorded, from which monophasic action potential duration (MAPD) was measured. RESULTS: Repeated injections of ioxaglate and sodium meglumine-diatrizoate did not potentiate initial decrease in LV pressures and inotropy, but the secondary increase in LV inotropy increased more after repeated injections than after a single injection. Repeated injections of iohexol increased LV inotropy more than a single injection. All contrast media prolonged MAPD more after repeated injections than after single injections. MAPD was prolonged 30 sec after the last injection. CONCLUSION: Repeated injections of contrast media cause greater cardiac hemodynamic and electrophysiologic effects than a single injection during selective coronary arteriography.

Action Potentials↗
PubMed2006

Osteogenic protein-1 injection into a degenerated disc induces the restoration of disc height and structural changes in the rabbit anular puncture model.

STUDY DESIGN: In vivo study of the effect of injection of osteogenic protein-1 (OP-1) on a rabbit anular needle puncture model of intervertebral disc (IVD) degeneration. OBJECTIVE: To study radiographic, magnetic resonance imaging (MRI), biochemical, and histologic changes in the rabbit IVD after injection of OP-1 into the nucleus pulposus in a needle puncture disc degeneration model. SUMMARY OF THE BACKGROUND DATA: Growth factors, such as OP-1, have the ability to stimulate synthesis of proteoglycans and collagen in vitro. The in vivo injection of OP-1 into the normal rabbit IVD has increased disc height and proteoglycan content in the anulus fibrosus and nucleus pulposus. However, to our knowledge, no attempts have yet been made to determine the effects of these growth factors in an in vivo model of disc degeneration. METHODS: New Zealand adolescent white rabbits (n = 90, 8 for baseline evaluation, 82 at 8 times) received an anular puncture in 2 noncontiguous discs with an 18-gauge needle to induce disc degeneration. Four weeks later, either 5% lactose (10 microL) or OP-1 (100 microg in 10 microL 5% lactose) was injected into the center of the nucleus pulposus. The disc height was followed radiographically for up to 24 weeks after the injections. At the 2, 4, 8, 12, and 24-week times after the injection, rabbits were euthanized, and MRI of the harvested spinal columns was obtained to grade the degeneration. The discs injected with OP-1 or lactose and noninjected discs were subjected to biochemical and histologic analysis. The specimens at the 24-week time were limited to histologic evaluation. RESULTS: The anular puncture with a needle induced a consistent disc narrowing within 4 weeks. The injection of OP-1 induced a restoration of disc height at 6 weeks, which was sustained for the entire experimental period, up to 24 weeks after the injection. The injection of lactose alone did not change the course of disc narrowing over the same time. MRI grading score showed significant differences between the OP-1 and lactose groups at the 8, 12, and 24-week times, suggesting an increase in water content in the nucleus pulposus of the OP-1 group. The proteoglycan content of the nucleus pulposus and anulus fibrosus was significantly higher in the OP-1 group than in the control group. The degeneration grades of the punctured discs in the OP-1 group were significantly lower than those in the lactose group. CONCLUSION: The results of this study show the feasibility of restoring degenerative rabbit discs by a single injection of OP-1 into the nucleus pulposus. Importantly, the effects of the OP-1 injection on disc height were sustained for up to 24 weeks. The metabolic changes in the cells, following a single injection, might be sustained and, thus, induce long-term changes in disc structure. An efficacy study in large animals is required to show further that the intradiscal injection of OP-1, or bone morphogenetic proteins or growth factors with similar properties would be useful for the structural restoration of the IVD in humans.

Animals↗
PubMed1987

IgM antibody production in mice intraperitoneally injected with zirconium oxychloride.

The effect of zirconium (Zr) on the humoral immune response was studied by measuring the level of IgM-plaque forming cells (IgM-PFC) against sheep red blood cells (SRBC) in the spleen of C57 BL mice intraperitoneally injected with zirconium oxychloride. Two experiments, a single injection of zirconium oxychloride of 1/5, 1/10, 1/50, and 1/100 of the LD50 for intraperitoneal injection and continuous injection of 1/20, 1/40, and 1/80 of the LD50 every other day for two or four weeks in mice, were carried out. In the case of a single injection zirconium oxychloride was intraperitoneally injected on days -1, 0, +1, +2, and +3 in relation to SRBC immunisation. The following conclusions may be drawn from this study: (1) Zr was shown to have an adjuvant like activity in relation to the humoral immune response, at least to IgM antibody production; (2) this effect was recognised not only with a single injection with Zr but also after continuous injection; (3) a single injection of Zr was more effective when the mice were treated with Zr 24 hours before or after SRBC immunisation; and (4) with regard to an injected dose of Zr, it was shown that a lower dose (1/50, 1/100 of the LD50 for a single injection and 1/40, 1/80 of the LD50 for continuous injection) led to a more enhanced level of IgM-PFC than a higher dose (1/5, 1/10 of the LD50 for a single injection, and 1/20 of the LD50 for continuous injection).

Animals↗