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PubMed1993

Suppressive effect of doxorubicin on liver recurrence after resection of colonic VX2 cancer lesions: difference in efficacy according to the injection protocol.

An animal model with liver cancer recurrence was induced by resecting colonic VX2 cancer lesions in 57 rabbits, and the effects of doxorubicin (ADR) on the recurrence were examined. Animals were divided into a control group and three chemotherapeutic groups: a portal injection group, to which ADR was injected into the portal vein after resection of the primary lesions; a peripheral injection group, to which ADR was injected into a peripheral vein after resection; and a preoperative injection group, to which an ADR dose of 0.5 mg/kg was peripherally injected 0, 1, and 2 days prior to resection followed by a portal injection of ADR 0.5 mg/kg after resection. The rate of liver recurrence was 100% in the control group, whereas it was 0% and 60% in the portal ADR 1.0 and 0.5 mg/kg injection groups, and 60% and 100% in the peripheral ADR 1.0 and 0.5 mg/kg injection groups. In the preoperative group, the rate was 0%, 100%, and 67% in the animals injected 2, 1, and 0 days prior to resection, respectively. These results suggest that portal injection or appropriate combinations of preoperative peripheral and portal injections of ADR are more effective than peripheral or portal injection alone in the suppression of liver recurrence.

Animals↗

PubMed1991

Self-injection of barbiturates, benzodiazepines and other sedative-anxiolytics in baboons.

Self-injection of 12 sedative-anxiolytics was examined in baboons. Intravenous injections and initiation of a 3-h time-out were dependent upon completion of a fixed-ratio schedule requirement, permitting eight injections per day. Before testing each dose of drug, self-injection performance was established with cocaine. Subsequently, a test dose was substituted for cocaine. At some doses, all five of the benzodiazepines examined (alprazolam, bromazepam, chlordiazepoxide, lorazepam, triazolam) maintained rates (number of injections per day) of drug self-injection above vehicle control in each of the baboons tested. Maximum rates of benzodiazepine self-injection were generally submaximal. Of the benzodiazepines examined, triazolam maintained the highest rates of self-injection. Among the three barbiturates tested, methohexital generally maintained high rates of self-injection in contrast to hexobarbital and phenobarbital, which only maintained low rates. Of the four non-benzodiazepine non-barbiturate sedatives examined, both chloral hydrate and methyprylon occasionally maintained high rates of self-injection. Although there were differences within and across animals, baclofen maintained intermediate rates of self-injection. The novel anxiolytic buspirone maintained only low rates of self-injection that were not different from vehicle. This study further validates the self-injection methodology for assessing sedative-anxiolytic abuse liability and provides new information about drug elimination rate as a determinant of drug self-administration.

Animals↗

PubMed2006

Sonography of the iliopsoas tendon and injection of the iliopsoas bursa for diagnosis and management of the painful snapping hip.

OBJECTIVE: The purpose of this study was to compare sonographic evaluations of patients referred with suspected snapping of their iliopsoas tendon with the pain relief achieved from anesthetic injection of the iliopsoas bursa, and with the subsequent surgical outcome. This study also assessed the effectiveness of Kenalog injection into the iliopsoas bursa for long-term pain relief. PATIENTS AND METHODS: Dynamic and static sonography was performed in 40 patients with clinically diagnosed snapping hips. The iliopsoas bursa was injected with Bupivicaine and Lidocaine in the first 22 patients, and an additional 1 ml Kenalog-40 was added to this mixture in the last 18 patients. We compared the static and dynamic sonographic findings with change in the patients' level of pain at 2 days after anesthetic injection. The sonographic findings and response to anesthetic injection were also compared to the response to Kenalog injection and the results of any subsequent surgery. RESULTS: Static sonography of the iliopsoas tendon was normal in 38 patients, and detected iliopsoas bursitis in one patient and iliopsoas tendinopathy in another. Snapping of the iliopsoas tendon was observed using dynamic sonography in 9 of the 40 patients. Following anesthetic injection of the iliopsoas bursa, 29 patients had complete or partial pain relief, and 11 patients had no pain relief. Eight of the nine patients with a snapping iliopsoas tendon had complete or partial pain relief from the bursal injection. Twelve of the 29 patients with pain relief after anesthetic injection later had an arthroscopic iliopsoas tendon release, and all of these 12 patients had a good postoperative result. Of the 18 patients who had Kenalog-40 injected into the iliopsoas bursa and did not have iliopsoas surgery, 16 had sustained pain relief following the injection. CONCLUSIONS: Patients with groin pain and a clinically suspected snapping iliopsoas tendon can benefit from injection into the iliopsoas bursa even if the snapping tendon is not visualized sonographically. The use of a corticosteroid may provide long-term pain relief, and pain relief after injection is a predictor of good outcome after surgical release of the iliopsoas tendon.

Adolescent↗

PubMed1995

Echogenicity of experimental liver ethanol injections.

Percutaneous ethanol injection therapy under sonographic guidance suffers from the occasional adverse spread of ethanol. We tried to optimize the technique to obtain the maximal echogenicity of injections. Eight dead pig livers were injected with ethanol and the consequent echogenicity was correlated with the time lapse after the injection, the speed of injection, the injected dose and the concentration of ethanol. For the sake of comparison, ethanol was also injected into processed sour milk. The injected lesions became smaller (P < 0.001), less sharply demarcated and less echogenic (P < 0.001) with time. Speeding up the injection (P < 0.05) and concentrating the ethanol (P < 0.05) increased echogenicity, whereas enlarging the dosage did not. Injections of ethanol into processed sour milk induced hyperechoic zones similar to the liver injections. It is concluded that quick injections of concentrated ethanol would be best detected. Injections should be monitored while they are still taking place, because the echogenicity will soon decrease. This immediate echogenicity seems to be caused by flow and the inherent properties of ethanol.

Animals↗

PubMed2006

Risk of needlestick injuries by injection pens.

Injection pens are used by patients when auto-administering medication (insulin, interferon, apokinon etc.) by the subcutaneous route. The objective of this study was to evaluate the rate of injection pen use by healthcare workers (HCWs) and the associated risk of needlestick injuries to document and compare injury rates between injection pens and subcutaneous syringes. A one-year retrospective study was conducted in 24 sentinel French public hospitals. All needlestick injuries linked to subcutaneous injection procedures, which were voluntarily reported to occupational medicine departments by HCWs between October 1999 and September 2000, were documented using a standardized questionnaire. Additional data (total number of needlestick injuries reported, number of subcutaneous injection devices purchased) were collected over the same period. A total of 144 needlestick injuries associated with subcutaneous injection were reported. The needlestick injury rate for injection pens was six times the rate for disposable syringes. Needlestick injuries with injection pens accounted for 39% of needlestick injuries linked with subcutaneous injection. In all, 60% of needlestick injuries with injection pens were related to disassembly. Injection pens are associated with needlestick injuries six times more often than syringes. Nevertheless, injection pens have been shown to improve the quality of treatment for patients and may improve treatment observance. This study points to the need for safety-engineered injection pens.

Disposable Equipment↗

PubMed2005

Ptosis and orbital fat prolapse after posterior sub-Tenon's capsule triamcinolone injection.

PURPOSE: To describe the occurrence of orbital fat prolapse and blepharoptosis after posterior sub-Tenon (PST) triamcinolone injection. DESIGN: Retrospective review of consecutive case series. PARTICIPANTS: Patients with ptosis and orbital fat herniation after PST triamcinolone injection. METHODS: Charts of all patients with ptosis and orbital fat herniation presenting after PST triamcinolone injection to the oculoplastics service of the Cole Eye Institute between 1999 and 2003 were reviewed. Charts were reviewed for patient age, indication, dates of injections, time to patient complaint or time to referral for ptosis, and marginal reflex distance (MRD1). MAIN OUTCOME MEASURES: Ptosis and orbital fat herniation after PST triamcinolone injection. RESULTS: Eleven patients with a history of ipsilateral PST triamcinolone injections were seen with ptosis and orbital fat prolapse. Ten charts were available for review. Mean patient age was 64 years (range, 45-78 years). Patients underwent 1 to 9 ipsilateral injections, and 2 patients underwent bilateral injections. Patients were seen for ptosis evaluation on average 22.5 months (range, 3-56 months) after the initial injection, and 6.6 months (range, 0-20 months) after the most recent injection. All patients demonstrated significant orbital fat prolapse in conjunction with statistically significant ptosis (P = 0.016). Tissue was obtained in 3 cases. Histologic findings in 1 case showed orbital fat infiltrated by histiocytes that seemed to contain phagocytosed material. CONCLUSIONS: Posterior sub-Tenon triamcinolone injection may cause ptosis associated with orbital fat prolapse. This finding may be a relatively common complication of PST triamcinolone injection. We recommend counseling patients about this risk before PST triamcinolone injection.

Adipose Tissue↗

PubMed2003

Injection practices in southern part of India.

The World Health Organization defines 'a safe injection' as one that does not harm the recipient, does not expose the provider to any avoidable risk, and does not result in any waste that is dangerous to the community. Irrational and unsafe injection practices are rife in developing countries. The objective of the present study was to assess the injection practices in the state of Tamilnadu, India, using the Rapid assessment and response guide of the Safe Injection Global Network of the World Health Organization. Thirty-nine prescribers, 62 providers, and 175 members of the general public were interviewed. The areas were chosen out of convenience while at the same time adhering to the guidelines. The study was carried out between April and June 2001. The per capita injection rate was 2.4 per year. The ratio of therapeutic to immunization injections was 6.5:1, and the proportion of injections given with a disposable syringe and needle was 35.4%. Knowledge about diseases transmitted by unsafe injections, for example involving human immunodeficiency virus and hepatitis B virus, was greater among all the study groups. The annual incidence of needlestick injuries among providers was 23.6, which is extremely high. It is concluded that there are deficiencies in practice such as an excessive, unwarranted usage of injections, a sizeable prevalence of unsafe injection practices, the short supply of injection equipment leading to a high incidence of needlestick injuries, a low proportion of hepatitis B virus immunization among providers, and a lack of adequate sharps containers and disposal facilities in this part of India. It is suggested that immediate and long-term remedial measures, such as the education of prescribers to reduce the number of injections to a bare minimum, an adequate supply of injection equipment, provider protection with immunization for hepatitis B virus, the provision of adequate sharps containers with safe disposal facilities and, not least, community education, be undertaken to avoid the future epidemic of transmissible diseases.

Acquired Immunodeficiency Syndrome↗

PubMed2003

Experimental study of relationship between intracoronary alcohol injection and the size of resultant myocardial infarct.

BACKGROUND: Hypertrophic obstructive cardiomyopathy (HOCM) is a complex disease with unique pathophysiologic characteristics and a great diversity of morphologic,functional and clinical features. Percutaneous transluminal septal myocardial ablation (PTSMA) using alcohol injection via a catheter into the septal branch of the left anterior descending coronary artery has been recently introduced as a promising nonsurgical therapy for HOCM. However, the relationship between the volume and velocity of intracoronary injection of absolute alcohol and the size of the resultant myocardial infarct has not been investigated. We therefore studied such a relationship in piglets. OBJECTIVES: To investigate the relationship between the volume and velocity of selective intracoronary alcohol injection by means of a catheter and the size of the resultant myocardial infarction. METHODS: Twenty piglets were equally divided at random into four groups (n=5 in each) according to the volume and the velocity of intracoronary absolute alcohol injection and the coronary arteries injected. Group I: the volume and velocity of injection of alcohol into the left circumflex coronary artery (LCX) were 0.5 ml and 0.2 ml/s, respectively. Group II: the volume and velocity of injection into LCX were 2.0 ml and 0.2 ml/s, respectively. Group III: the volume and velocity of injection of alcohol into the left anterior descending coronary artery (LAD) were 1.2 ml and 0.06 ml/s, respectively. Group IV: the volume and velocity of injection into the LAD were 1.2 ml and 1.2 ml/s, respectively. The resultant myocardial infarcts were then quantitatively measured 6 h after myocardial ablation. RESULTS: The myocardial infarct size for group I was 4.26+/-2.71(%), for group II was 10.12+/-4.55(%), for group III was 5.84+/-1.21(%) and for group IV was 7.11+/-1.63(%). There were significant differences in myocardial infarct size with different volumes of intracoronary absolute alcohol injection (0.02<P<0.05). but there were no apparent differences found in myocardial infarct size with different velocities of intracoronary alcohol injection (0.05<P<0.2). CONCLUSIONS: The myocardial infarct size is directly related to the volume of intracoronary absolute alcohol injection during myocardial ablation by a catheter, but has no relation to the injection velocity.

Animals↗

PubMed1997

The influence of the timing of bupivacaine infiltration on the time course of inflammation induced by two carrageenin injections seven days apart.

The mechanical allodynia and edema related to a subcutaneous carrageenin injection are increased by a conditioning carrageenin injection 7 days before (Guilbaud et al., 1992). In the present study, the possibility of preventing this by bupivacaine infiltration was tested. In the first part of the experiment, the time course of a carrageenin induced inflammation of the right hind paw was assessed in animals receiving local anesthetic injection (0.2 ml of bupivacaine 0.5% solution with epinephrine) either 5 min before (BUPI PRE group) or 60 min after (BUPI POST group) the carrageenin injection (0.2 ml of 1% solution). Control groups received saline (0.2 ml) with the same timing. In the second part of the experiment, 7 days later, a carrageenin injection was performed either in the right or the left hind paw. Mechanical allodynia and edema were evaluated by the vocalization threshold to paw pressure (VTPP) and paw circumference (PC) in both hind paws at 1, 2, 4, 24 h and 7 days after both carrageenin injections. The first carrageenin injection induced mechanical allodynia and edema maximal at 240 min (42% reduction of VTPP; 23% increase in PC) and the influence of bupivacaine on the VTPP and PC was similar to previous results (Fletcher et al., 1996). The second ipsilateral carrageenin injection induced a more pronounced inflammation in the control groups and BUPI POST group than the first injection (P < 0.001). In contrast, the increase in allodynia and edema was less intense in the BUPI PRE group than in the other groups (P < 0.0001 and P < 0.02 respectively). Bupivacaine injections had no effect on allodynia and edema related to a second contra-lateral carrageenin injection. These results suggest that bupivacaine infiltration, when administered before the first conditioning injection of carrageenin, can prevent the reinforcement of mechanical allodynia and edema related to a second ipsilateral injection of carrageenin 7 days later.

Analysis of Variance↗

PubMed1996

Hemodynamic characteristics, myocardial kinetics and microvascular rheology of FS-069, a second-generation echocardiographic contrast agent capable of producing myocardial opacification from a venous injection.

OBJECTIVES: We sought to 1) study the effects of FS-069 on cardiac and systemic hemodynamic function, myocardial blood flow, left ventricular wall thickening and pulmonary gas exchange when injected intravenously; and 2) compare the myocardial kinetics and microvascular rheology of FS-069 and Albunex when injected directly into a coronary artery. BACKGROUND: FS-069 is a second-generation echocardiographic contrast agent composed of perfluoropropane-filled albumin microspheres; it is capable of consistent and reproducible myocardial opacification from a venous injection. METHODS: Nine dogs were used to study the effects of FS-069 on hemodynamic function, pulmonary gas exchange, left ventricular wall thickening and myocardial blood flow and to characterize its myocardial kinetics when injected intravenously. These dogs were also used to compare the myocardial kinetics of FS-069 with those of Albunex during intracoronary injections. Nine Sprague-Dawley rats were used to compare the microvascular rheology of these two contrast agents, and in vitro modeling was performed to assess whether the microvascular findings of FS-069 can explain its echocardiographic behavior during direct coronary injections. RESULTS: There were no effects of 30 rapid venous injections of FS-069 (every 20 s) on cardiac output; mean aortic, pulmonary or left atrial pressures; and peak positive and negative first derivative of left ventricular pressure (dP/dt). Similarly, there were no effects of this agent on radiolabeled microsphere-measured regional myocardial blood flow, left ventricular wall thickening or pulmonary gas exchange. When injected intravenously, the myocardial transit of this agent resembled a gamma-variate form. When diluted FS-069 was injected directly into the coronary artery; however, its transit resembled the integral of gamma-variate function, with persistent myocardial opacification lasting several minutes, which was different from that of Albunex. Intravital microscopy revealed that, unlike Albunex, when no bubbles are entrapped within the microcirculation after an arterial injection, a very small fraction of the diluted, larger FS-069 microbubbles are entrapped. In vitro modeling confirmed that this small fraction of microbubbles can result in persistent myocardial opacification. CONCLUSIONS: FS-069 produces no changes in hemodynamic function, myocardial blood flow, left ventricular wall thickening or pulmonary gas exchange when injected intravenously in large amounts. When diluted FS-069 is injected into the coronary artery, a very small fraction of the larger bubbles are entrapped within the microcirculation, resulting in a persistent contrast effect. Thus, although FS-069 is a safe intravenous echocardiographic contrast agent, it cannot provide information on myocardial blood flow when injected directly into a coronary artery.

Albumins↗

PubMed2002

Treatment of tendon disorders. Is there a role for corticosteroid injection?

Tendon injuries and other tendon disorders are a source of major concern in competitive and recreational athletes and in many working conditions requiring repetitive movements. The exact etiology, pathophysiology, and healing mechanisms of the various tendon complaints are, however, only partly known and even origin of pain in the chronic tendon disorders is unknown. Thus, the treatment strategies recommended for tendon complaints vary considerably and the given treatment is frequently based on empirical evidence only. Corticosteroid injections are one of the most commonly used treatments for chronic tendon disorders. Despite their popularity, the biologic basis of their effect and the systematic evidence for their benefits are largely lacking. In addition to suppressing inflammation, the effects of local corticosteroid injections could be mediated through their effect on the connective tissue and adhesions between the tendon and the surrounding peritendinous tissues by inhibiting the production of collagen, other extracellular matrix molecules, and granulation tissue in these sites. Also, if the pain in tendinopathy is a result of stimulation of nociceptors by chemicals released by the damaged, degenerated tendon, corticosteroids might mediate their effect thorough alterations in the release of these noxious chemicals, the behavior of these receptors, or both. Achilles tendinopathy, rotator-cuff tendinopathy, tennis elbow, and trigger finger are among the most frequent tendon problems. There is good evidence, however, strongly supporting the use of local corticosteroid injections in the trigger finger only. This can be to the result of either a true lack of the effect or just a lack of good trials in the other complaints. Intimidation with adverse effects of peritendinous corticosteroid injections is based on case reports only rather than convincing data from controlled clinical studies. In light of the animal studies, corticosteroid injection into tendon substance should be avoided, although the true incidence of side effects after local corticosteroid injection(s) for tendon disorders is unknown. Also, the relevance of the steroid used, the tissue affected, the extent of the tendon problem, the duration of the symptoms, the phase of healing at the time of injections, and the postinjection events remain undetermined. Although a complete tendon rupture with loading after steroid injection has been reported, no reliable proof exists of the deleterious effects of peritendinous injections; conclusions in literature are based mainly on uncontrolled case reports that fail under scientific scrutiny, whereas scientifically rigorous studies have not been performed. An acute tendon disorder often responds favorably to early intervention with conservative treatment modalities. Local corticosteroid injections gives good short-term results in prolonged or subacute cases that do not respond to the conventional conservative treatments. Although corticosteroid injections are one of the most commonly used treatment modalities for chronic tendon disorders, there is an obvious lack of good trials defining the indications for and efficacy of such injections, and subsequently, many of the recommendations for the use of local corticosteroid injections do not rely on sound scientific basis. Thus, there is an obvious need for high-quality basic science studies and controlled clinical trials in examining the effects corticosteroids on various tendon disorders.

Adrenal Cortex Hormones↗

PubMed2003

Ultrasound-guided botulinum toxin injection technique for the iliopsoas muscle.

Intramuscular botulinum toxin A injections are beneficial for the treatment of functional shortening of the iliopsoas muscle, but it is difficult to achieve precise needle positioning and injection. As a solution to this we present an ultrasound-guided injection technique for the iliopsoas muscle using an anterior approach from the groin. The procedure was performed 26 times in 13 patients (seven males, six females; mean age 11 years, SD 9 years 8 months; age range 4 to 31 years), 10 times bilaterally. Indications were functional iliopsoas shortening due to cerebral palsy (17 hips), hereditary spastic paraplegia (four hips), and Perthes disease (five hips). In all cases the iliopsoas muscle was identified easily by ultrasound; the placement of the injection needle and injection into the site of interest were observed during real time. No complications were encountered. Botulinum toxin A (BTX-A) injections have become established as a standard procedure for the treatment of functional shortening of different muscles in persons with spasticity or dystonia (Kessler et al. 1999, Bakheit et al. 2001, Kirschner et al. 2001). Optimal needle placement is essential to avoid severe side effects and to assess lack of response to the drug or incorrect region of injection. While injection into superficial, very palpable muscles is quite easy, the approach to other muscles such as the iliopsoas muscle may be more difficult and the placement of the needle for an optimal injection site is harder to control. As a solution to this, we present an ultrasound-guided injection technique. The main indications for BTX-A injections in the iliopsoas muscle are dynamic hip flexion deformities mostly due to spastic conditions which may compromise walking (increased anterior pelvic tilt during the whole gait cycle, decreased hip extension at terminal stance, increased peak hip flexion during swing; Molenaers et al. 1999. Another indication might be decentration of the femoral head (as part of an injection programme which also includes other muscles like the adductors and the medial hamstrings) for pain relief, reducing care difficulties and, possibly, prevention of further decentration (Porta 2000, Foster et al. 2001, Deleplanque et al. 2002, Lubik et al. 2002). In Perthes disease, BTX-A injections in the iliopsoas muscle and the adductors may prevent a fixed deformity, which is a negative prognostic factor.

Adult↗

PubMed2000

Secondary heat, but not mechanical, hyperalgesia induced by subcutaneous injection of bee venom in the conscious rat: effect of systemic MK-801, a non-competitive NMDA receptor antagonist.

Subcutaneous (s.c.) administration of bee venom into the plantar surface of one hind paw in rats has been found to produce an immediate single phase of persistent spontaneous nociceptive responses (continuously flinching, licking or lifting the injected paw) for 1-2 h accompanied by a 72-96 hour period of primary heat and mechanical hyperalgesia in the injection site and a spread of heat, but not mechanical, hyperalgesia in the non-injected hind paw (Chen et al., 1999b). To gain insight into the underlying mechanisms of the bee venom-induced hyperalgesia in particular, we further identified a heat, but not mechanical, hyperalgesia in an area (paw pad) distant from the injection site induced by s.c. injection of bee venom into the posterior leg 0.8-1.2 cm proximal to the heel measured by paw withdrawal reflex to radiant heat or von Frey monofilament stimuli in conscious rats. In the bee venom-treated hind limb, however, significant reduction in both thermal latency and mechanical threshold of withdrawal reflex was identified for a period of more than 96 h in the heel with a similar characteristic to the primary heat and mechanical hyperalgesia identified in the injection site previously. The time course of the heat hyperalgesia identified in the paw pad of the bee venom-treated side was shorter and lasted for less than 48 h, which was in parallel with the reduction in thermal latency of the withdrawal reflex identified in the non-injected hind paw. Moreover, pre- or post-treatment with a single dose of MK-801 (0.01 mg/kg, i.p.), a non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist, completely blocked the occurrence, and reversed the established process of the heat hyperalgesia identified in either the bee venom-treated or non-treated paw pads, while the same treatments with the drug did not produce any influence upon the development and maintaining of the heat and mechanical hyperalgesia identified in the heel of the injected hind limb. Taken together with our previous results following s.c. intraplantar bee venom injection, we conclude that: (1) in addition to the well-identified primary heat and mechanical hyperalgesia in the injection site and its adjacent area, s.c. bee venom is also able to produce a secondary heat hyperalgesia in a region distant from the injection site which has a similar characteristic to the contralateral heat hyperalgesia; (2) NMDA receptors are involved in either development or maintenance of the secondary and the contralateral heat hyperalgesia, but without any role in those processes of the primary heat and mechanical hyperalgesia; (3) the secondary heat hyperalgesia seen in the injected hind limb is likely to share the same neural mechanisms with that identified in the non-injected side via co-activation of NMDA receptors.

Animals↗

PubMed2002

The targeting accuracy of subacromial injection to the shoulder: an arthrographic evaluation.

PURPOSE: The study goal was to examine the targeting accuracy of subacromial injection to the shoulder and the influence of the location of the injected structure. TYPE OF STUDY: A prospective nonrandomized study. METHODS: Fifty-three patients (56 shoulders; 34 women and 19 men; mean age, 74.5 years; range, 49 to 91) with impingement signs (Neer, Hawkins) of at least 2 months' duration received a subacromial injection of a mixture of 0.5 mL (2.5 mg) betamethasone acetate and 3 mL of radiographic contrast material (iotrolan) and 7 mL of 1% lidocaine using a lateral approach. Radiographs of the shoulder joint were taken immediately after the injection to determine the structure reached by the injection. Details of pain expressed as Neer and Hawkins impingement signs were obtained before and 15 minutes after the injection, and subjectively assessed using a 4-point self-administered pain score. Pain reduction resulting from subacromial and intradeltoid injection was compared. RESULTS: Thirty-nine of the 56 injections (70%) were judged to have reached the subacromial bursa. Twelve (21%) were seen to have entered the deltoid muscle; 2 (4%) were in the glenohumeral joint; and 3 (5%) were subcutaneous. A comparison of subacromial bursal with intradeltoid injection showed no significant differences in pain reduction expressed as impingement signs (1.5 vs 1.7 in the Neer impingement sign and 1.6 vs 1.6 in the Hawkins impingement sign, respectively). CONCLUSIONS: This study showed that subacromial injection was a relatively difficult procedure. A high incidence of injections that missed the subacromial bursa would be a sufficient reason to refrain from repeated usage of corticosteroids. These results also suggest that pain relief could be attained whether the injected material reached the subacromial bursa or the deltoid muscle. Successful pain relief after intradeltoid injection seems to call into question the diagnostic value of a positive Neer impingement test.

Aged↗

PubMedDate not supplied

[Side effects and complications of injection therapy for degenerative spinal disorders].

AIM: The type and frequency of side effects due to treatment of vertebral pain syndromes with local injections were examined. Risks and complications were evaluated and precautions are presented in order to avoid these problems. METHODS: The medical records of 453 patients who had undergone injection therapy in hospital for spinal pain syndromes were investigated retrospectively. RESULTS: Paravertebral injections with cervical and lumbar spinal nerve analgesia, facet joint injections, lumbar epidural-perineural injections, epidural-dorsal and epidural-sacral injections, and injections next to the ileosacral joint were administered, amounting to a total of 7 963 injections. In 25 cases (0.3 %) unfavourable side effects were observed. Epidural-perineural injections led to headache in 10 cases and paravertebral lumbar nerve analgesia in 3 cases. Five times after epidural-perineural injections circulatory dysregulation with vertigo, nausea and decreased blood pressure was observed. One patient fell after an epidural-perineural injection, and one patient developed a sensory block up to the thoracic segment 6. Five patients showed local allergic reactions at the injection site after Mepivacain. All complications could be treated with simple symptomatic measures and had no severe effects. CONCLUSION: Compared to other studies, only few side effects were observed. The injections described above may thus be regarded as low-risk therapy.

Adolescent↗

PubMed1998

Endoscopic injection of botulinum toxin for biliary sphincter of Oddi dysfunction.

BACKGROUND AND STUDY AIMS: Endoscopic sphincterotomy is not without risks, and is also ineffective in about half of patients with type III sphincter of Oddi dysfunction (SOD), i.e. those without clinical evidence of biliary obstruction (normal liver tests, normal bile duct diameter, and regular drainage time at endoscopic retrograde cholangiography). The present study therefore investigated the efficacy and safety of endoscopic botulinum toxin (BTX) injection into the papilla of Vater, and analyzed whether the symptomatic response to BTX injection might be a predictor of outcome for endoscopic sphincterotomy. PATIENTS AND METHODS: Twenty-two patients who had undergone cholecystectomy and had manometrically confirmed type III SOD were enrolled during a three-year study period. All patients received treatment with an endoscopic single-shot injection of 100 mouse units of BTX into the papilla of Vater. Initial symptomatic responses were analyzed six weeks later. If the BTX injection had been ineffective, or if biliary symptoms recurred after initial benefit during the follow-up period, endoscopic manometry and endoscopic sphincterotomy were performed. All patients then received further prospective clinical follow-up examinations. RESULTS: With the exception of one patient with mild pancreatitis (4.5%), no side effects were observed after endoscopic BTX injection. Six weeks after BTX injection, 12 SOD patients (55%) were symptom-free, but ten patients (45%) were not. However five of these ten SOD patients who did not experience symptomatic benefit from BTX injection had normal basal sphincter of Oddi pressures (< 40 mmHg) at this time, and none of these five patients was free of complaints after subsequent endoscopic sphincterotomy. Two of the remaining five patients with sustained sphincter hypertension after BTX injection benefitted from endoscopic sphincterotomy. Eleven of the 12 SOD patients who had initially responded to BTX injection developed recurrent symptoms after a median period of six months. Manometry revealed sphincter hypertension in all 11 cases, and all patients became free of complaints again after endoscopic sphincterotomy during a median follow-up of a further 15 months. Overall, 11 of the 12 patients who responded to BTX injection, versus two of the ten patients who did not gain pain relief after BTX injection, later benefitted from endoscopic sphincterotomy (p < 0.01). CONCLUSIONS: Endoscopic injection of botulinum toxin into the papilla of Vater is a safe procedure and provides short-term relief of symptoms in half of patients with type III SOD. Our results also indicate that the clinical response to BTX injection can predict whether SOD patients will gain long-term benefit from endoscopic sphincterotomy.

Adult↗

PubMed1959

The cellular transformation of injected colloidal iron complexes into ferritin and hemosiderin in experimental animals; a study with the aid of electron microscopy.

As revealed by electron microscopy and electron diffraction, the physical state of ferric hydroxide micelles contained in iron-dextran, saccharated iron oxide, and hydrous ferric oxide ("ferric hydroxide") differs notably from the state of the ferric hydroxide in ferritin or hemosiderin. By virtue of this difference one can trace the intracellular transformation of colloidal iron, administered parenterally, into ferritin and hemosiderin. One hour after intraperitoneal injection of iron-dextran or saccharated iron oxide into mice, characteristic deposits were present in splenic macrophages, in sinusoidal endothelial cells of spleen and liver, and in vascular endothelial cells of various renal capillaries. Four hours after injection, small numbers of ferritin molecules were identifiable about intracellular aggregates of injected iron compounds; and by the 6th day, ferritin was abundant in close proximity to deposits of injected iron compounds. The latter were frequently situated in cytoplasmic vesicles delimited by single membranes. These vesicles were most frequently found in tissue obtained during the first 6 days after injection; and in certain of the vesicles ferritin molecules surrounded closely packed aggregates of injected material. Much unchanged ferric hydroxide was still present in macrophages and vascular endothelial cells 3 to 4 weeks after injection. While electron microscopy left no doubt about the identity of injected ferric hydroxide on the one hand, and of ferritin or hemosiderin on the other, histochemical tests for iron failed in this respect. Precipitation of ferric hydroxide (hydrous ferric oxide) from stabilized colloidal dispersions of iron-dextran was brought about in vitro by incubation with minced mouse tissue (e.g. liver), but not by incubation with mouse serum or blood. Subcutaneous injections of hydrous gel of ferric oxide into mice initially produced localized extracellular precipitates. Most of the material was still extracellular 16 days after injection, though part of it was phagocytized by macrophages near the site of injection; but apparently none reached the spleen in unaltered form. Five days after injection and thereafter, much ferritin was present in macrophages about the site of injection and in the spleen. The findings show that iron preparations widely used in therapy can be identified within cells, and that their intracellular disposition and fate can be followed at the molecular level. Considered in the light of previous work, they indicate that the characteristic structure of the ferric hydroxide micelles in molecules of ferritin is specific, and develops during the union of apoferritin with ferric hydroxide. Apparently this union does not depend upon specific cell components.

Animals↗

PubMed2006

Rapid dual-injection single-scan 13N-ammonia PET for quantification of rest and stress myocardial blood flows.

Quantification of myocardial blood flows at rest and stress using 13N-ammonia PET is an established method; however, current techniques require a waiting period of about 1 h between scans. The objective of this study was to test a rapid dual-injection single-scan approach, where 13N-ammonia injections are administered 10 min apart during rest and adenosine stress. Dynamic PET data were acquired in six human subjects using imaging protocols that provided separate single-injection scans as gold standards. Rest and stress data were combined to emulate rapid dual-injection data so that the underlying activity from each injection was known exactly. Regional blood flow estimates were computed from the dual-injection data using two methods: background subtraction and combined modelling. The rapid dual-injection approach provided blood flow estimates very similar to the conventional single-injection standards. Rest blood flow estimates were affected very little by the dual-injection approach, and stress estimates correlated strongly with separate single-injection values (r=0.998, mean absolute difference=0.06 ml min-1 g-1). An actual rapid dual-injection scan was successfully acquired in one subject and further demonstrates feasibility of the method. This study with a limited dataset demonstrates that blood flow quantification can be obtained in only 20 min by the rapid dual-injection approach with accuracy similar to that of conventional separate rest and stress scans. The rapid dual-injection approach merits further development and additional evaluation for potential clinical use.

Ammonia↗