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PubMed2004

Uniform vascular contrast enhancement and reduced contrast medium volume achieved by using exponentially decelerated contrast material injection method.

PURPOSE: To investigate in computed tomographic (CT) angiography whether an exponentially decelerated contrast medium injection, as compared with a standard constant-rate injection, can facilitate uniform vascular contrast enhancement with a reduced contrast material volume. MATERIALS AND METHODS: CT angiography of the abdominal aorta was performed in 46 subjects by using an exponentially decelerated injection method: 134 mL of contrast medium was injected for 40 seconds, starting at 4.0 mL/sec and decreasing exponentially to 2.7 mL/sec by the end of the injection. Twenty-one of these subjects also underwent CT angiography with a constant-rate injection: 160 mL of contrast medium was injected for 40 seconds at a constant rate of 4 mL/sec. Time-enhancement curves and the magnitude of peak vascular enhancement were measured. Enhancement uniformity was evaluated by using three indexes: (a) duration of contrast enhancement achieved within 80% of the peak (80% DCE), (b) SD of the normalized contrast enhancement (SDNCE) measured from the beginning of spiral CT scanning to the time when the enhancement decreased to a level lower than the beginning level, and (c) slope of the enhancement curve calculated by using linear regression analysis. RESULTS: Exponentially decelerated injection resulted in more uniform enhancement. Mean values generated by using exponentially decelerated versus constant-rate injection in 21 paired comparisons were, respectively, 30.8 seconds +/- 5.0 versus 22.6 seconds +/- 7.6 for 80% DCE, 0.052 +/- 0.017 versus 0.086 +/- 0.031 for SDNCE, and 0.47 HU/sec +/- 0.70 versus 2.27 HU/sec +/- 0.87 for slope (P <.001 for all indexes). Compared with the peak enhancement resulting from the constant-rate injection, that resulting from the exponentially decelerated injection was reduced by a mean of 17.2% +/- 10.0. CONCLUSION: Uniform vascular contrast enhancement and reduced contrast medium volume, which are desirable in CT angiography, can be achieved with exponentially decelerated injection.

Abdomen↗
PubMed2000

Multiphasic injection method for uniform prolonged vascular enhancement at CT angiography: pharmacokinetic analysis and experimental porcine model.

PURPOSE: To determine if multiphasic injection provides uniform, prolonged vascular contrast medium enhancement at computed tomographic (CT) angiography. MATERIALS AND METHODS: With a computer-based, compartmental model of the cardiovascular system, theoretic analysis was performed to estimate an injection algorithm for uniform, prolonged vascular enhancement. For algorithm validation, four pigs were scanned after intravenous injection of 50 or 70 mL of contrast medium (282 mg of iodine per milliliter). Uni-, bi-, and multiphasic injection schemes were tested. In most cases, the initial injection rate was 2 mL/sec. In each CT study, 27 dynamic images were acquired every 2 seconds at a fixed mid-abdominal aortic level. Time-enhancement curves were calculated. Injection duration, peak aortic enhancement, and enhancement uniformity (duration of enhancement achieved within 90% of the peak [90% DCE]) were evaluated. RESULTS: Theoretic and experimental results agreed well. Compared with uniphasic injection, biphasic injection resulted in more prolonged enhancement but generated two enhancement peaks with a valley between, and multiphasic injection yielded more uniform and prolonged enhancement. With 50- and 70-mL multiphasic injections, respectively, injection duration increased by 32% and 51%, peak enhancement decreased by 19% and 18%, and 90% DCE increased by 81% and 94%. CONCLUSION: Uniform, prolonged vascular enhancement, which is desirable for CT angiography and essential for steady-state quantification of blood volume in organs, can be achieved with multiphasic injection.

Angiography↗
PubMed1998

Change of peripheral levels of pituitary hormones and cytokines after injection of interferon (IFN)-beta in patients with chronic hepatitis C.

Interferons (IFNs) are now in use worldwide for the treatment of chronic viral hepatitis. Unfortunately, various side effects of IFNs have been reported. Because cytokines, which include IFNs, can affect endocrine function, endocrinological abnormalities are sometimes observed in patients treated with IFNs. We examined the effects of IFN-beta on peripheral levels of pituitary and adrenal hormones and cytokines. Six million international units of IFN-beta dissolved in glucose solution was injected for 30 min. As a control study, glucose solution without IFN-beta was injected. Pituitary hormones (ACTH, GH, TSH, prolactin (PRL), LH, FSH, and arginine-vasopressin (AVP)), cortisol, and cytokines such as interleukin (IL)-1, IL-6, tumor necrosis factor-alpha (TNF), and interleukin-1 receptor antagonist (IL-1ra) were measured before and after IFN-beta injection. The study was carried out on 14 patients with chronic hepatitis type C who were under treatment with IFN-beta. All studies were performed when the patients were afebrile. None of the patients had any endocrine or autoimmune diseases. Plasma ACTH levels increased significantly at 60-120 min after IFN-beta injection compared with the levels before IFN-beta injection and in the control study using glucose injection. Plasma cortisol levels increased after IFN-beta injection, in parallel with plasma ACTH elevation. Serum GH levels increased significantly at 120 min after IFN-beta injection. All the increased hormones including ACTH, cortisol, and GH, were decreased at the end of the study-180 min after IFN-beta injection. Serum levels of TSH, PRL, LH, FSH, and AVP were not changed significantly by IFN-beta injection. Plasma IL-1 and TNF levels did not change after IFN-beta injection, while IL-6 and IL-1ra were elevated significantly. The increases in IL-6 and IL-1ra were gradual, reaching their peak levels at 180 min after IFN-beta injection. However there were no correlations between the hormones measured in this study and the levels of IL-6 or IL-1ra. It would seem that IFN-beta has direct or indirect stimulatory effects for ACTH and GH without mediation of the cytokines. These in vivo results are important for investigating the relationship between endocrine and cytokine systems in humans.

Adrenal Cortex Hormones↗
PubMed2005

Activated injectable vitamin D and hemodialysis survival: a historical cohort study.

Patients with ESRD commonly experience secondary hyperparathyroidism, a condition primarily managed with activated injectable vitamin D. The biologic effects of vitamin D, however, are widespread, and it is possible that activated injectable vitamin D alters survival in ESRD. This hypothesis was tested in a historical cohort study of incident hemodialysis patients who lived throughout the United States between January 1996 and December 1999. The primary outcome was 2-yr survival among those who survived for at least 90 d after initiation of chronic hemodialysis. During this period, 51,037 chronic hemodialysis patients survived for at least 90 d from the initiation of hemodialysis, and in the ensuing 2 yr, 37,173 received activated injectable vitamin D and 13,864 did not. At 2 yr, mortality rates were 13.8/100 person-years in the group that received injectable vitamin D compared with 28.6/100 person-years in the group that did not (P < 0.001). Cox proportional hazards analyses adjusting for several potential confounders and examining injectable vitamin D therapy as a time-dependent exposure suggested that compared with patients who did not receive injectable vitamin D, the 2-yr survival advantage associated with the group that did receive injectable vitamin D was 20% (hazard ratio, 0.80; 95% confidence interval, 0.76 to 0.83). The incidence of cardiovascular-related mortality was 7.6/100 person-years in the injectable vitamin D group, compared with 14.6/100 person-years in the non-vitamin D group (P < 0.001). The benefit of injectable vitamin D was evident in 48 of 49 strata examined, including those with low serum levels of intact parathyroid hormone and elevated levels of serum calcium and phosphorus, situations in which injectable vitamin D is often withheld. Repeating the entire analysis using marginal structural models to adjust for time-dependent confounding by indication yielded a survival advantage of 26% (hazard ratio, 0.74; 95% confidence interval, 0.71 to 0.79) associated with the injectable vitamin D group. In this historical cohort study, chronic hemodialysis patients in the group that received injectable vitamin D had a significant survival advantage over patients who did not. Randomized clinical trials would permit definitive conclusions.

Calcitriol↗
PubMed1993

Percutaneous ethanol injection therapy for hepatocellular carcinoma: results in 146 patients.

OBJECTIVE: Sonographically guided percutaneous ethanol injection therapy has been used widely in the treatment of hepatocellular carcinoma. However, few reports have been published on the results of this treatment in large numbers of patients. Accordingly, we describe our experience with 146 patients who had this treatment. The study is an update of our previous reports on this subject. SUBJECTS AND METHODS: We used ethanol injection, with or without transcatheter arterial embolization, 1048 times in 146 patients who had 242 lesions of hepatocellular carcinoma. In 98 patients, ethanol injection was used to attempt a cure of the disease. In the remaining 48 patients, ethanol injection was used palliatively only to reduce the tumor burden. In most cases, 2-8 ml of absolute ethanol was injected in one treatment session. Patients were given the injections two or three times each week until ethanol was injected throughout the lesion. When tumors were greater than 2 cm in diameter, ethanol was injected into the edges of the lesion. RESULTS: Histopathologic examination after treatment in 21 cases showed that the lesion was completely necrotic in 15 cases, 90% necrotic in five cases, and 70% necrotic in the remaining case. Follow-up angiography performed in 69 cases showed no contrast stains in the treated tumors in 60 cases. Elevated serum levels of alpha-fetoprotein decreased in 39 of 43 cases. The 1-, 2-, 3-, 4-, and 5-year survival rates of all 146 patients were 79%, 64%, 46%, 38%, and 38%, respectively. Among 98 patients in whom ethanol injection was used as a potentially curative therapy, these rates were 85%, 70%, 62%, 52%, and 52%, respectively. After ethanol injection, the cancer recurred frequently; the 1-, 2-, 3-, 4-, and 5-year recurrence rates in the potentially curative group were 26%, 38%, 51%, 60%, and 60%, respectively. However, 84% of recurrences were new lesions in different portions of the liver; recurrence of lesions treated by ethanol injection was rare. Major complications of the treatment were peritoneal bleeding in two cases and pleural effusion in one case. CONCLUSION: Histopathologic examination, angiography, and serum levels of alpha-fetoprotein showed that percutaneous ethanol injection is a valuable treatment of hepatocellular carcinoma. The therapy increased the long-term survival of patients who have this disease.

Carcinoma, Hepatocellular↗
PubMed1995

Improved postprandial metabolic control after subcutaneous injection of a short-acting insulin analog in IDDM of short duration with residual pancreatic beta-cell function.

OBJECTIVE: To compare postprandial metabolic control after subcutaneous injection of a short-acting insulin analog [Lys(B289),Pro(B29)] (Lispro) or human regular insulin (Humulin R U-100 [Hum-R]) in insulin-dependent diabetes mellitus (IDDM) of short duration with residual beta-cell function. RESEARCH DESIGN AND METHODS: Six IDDM patients (age 25 +/- 2 years, diabetes duration 14 +/- 2 months, HbA1c 6.4 +/- 0.5%) with residual pancreatic beta-cell function (fasting plasma C-peptide 0.19 +/- 0.02 nmol/l) were studied on three different occasions. Postbreakfast plasma glucose was maintained at approximately 7.1 mmol/l by means of intravenous insulin until either 1200 when 0.1 U/kg Hum-R was injected or until 1225 when 0.1 U/kg of either Hum-R or Lispro was injected subcutaneously. Lunch (mixed meal, 692 Kcal) was served at 1230 (0 min). Six nondiabetic control subjects were also studied. RESULTS: After Lispro administration, the 120-min plasma glucose decreased more (6.1 +/- 0.3 mmol/l) than after injection of Hum-R at -30 min (7.7 +/- 0.3 mmol/l) or -5 min (9.9 +/- 0.2 mmol/l). By the end of the study, plasma glucose was still lower after Lispro was injected (6.7 +/- 0.3 mmol/l) than after Hum-R was injected at -30 min (7.6 +/- 0.3 mmol/l) or -5 min (7.3 +/- 0.2 mmol/l) (P < 0.05). Two IDDM patients required glucose to prevent hypoglycemia after being injected with Lispro, but four required glucose after being injected with Hum-R at -5 min (Lispro approximately 27 mmol glucose infused between 90 and 240 min; Hum-R approximately 80 mmol between 240 and 390 min). After Lispro, plasma insulin peaked earlier (at 30 min, 342 +/- 29 pmol/l) than after Hum-R injection at -30 min (at 90 min, 198 +/- 28 pmol/l) and was superimposable on that of nondiabetic subjects. In Hum-R injected at -5 min, plasma insulin peaked later (at 120 min) and subsequently remained greater than in the two other studies. CONCLUSIONS: Despite the lack of a time interval between injection and meal, Lispro controls postprandial plasma glucose concentration better than Hum-R given 30 min before meals and, to an even greater extent, better than Hum-R given 5 min before meals. In addition, Lispro minimizes the risk of postprandial hypoglycemia, thus closely mimicking the postprandial glucose homeostasis of nondiabetic subjects. IDDM patients with residual pancreatic beta-cell function are the ideal candidates for prandial use of Lispro because they can maintain near-normoglycemia longer after subcutaneous analog injection because of residual endogenous insulin secretion.

3-Hydroxybutyric Acid↗
PubMed1997

Unchanged insulin absorption after 4 days' use of subcutaneous indwelling catheters for insulin injections.

OBJECTIVE: Since 1985, we have used indwelling catheters (Insuflon, Maersk Medical, Lynge, Denmark; Chronimed, Minnetonka, MN) to lessen pain when injecting insulin. However, some patients experience a rise in blood glucose after using indwelling catheters for a few days. We therefore studied the absorption of 125I-labeled insulin when using indwelling catheters. RESEARCH DESIGN AND METHODS: Five men and five women participated (age 18-25 years, C-peptide negative, HbA1c 9.0 +/- 1.0% [mean +/- SD, DCA-2000 method], diabetes duration 5-21 [median 9.5] years). After thyroid blockage with potassium iodide, we injected 5IU of 125I-labeled short-acting insulin subcutaneously in the abdomen ("ordinary injection") and 5 IU on the contralateral side through an indwelling catheter ("catheter injection"). The injection/insertion area was free of lipohyper- and lipohypotrophies. Disappearance rate was measured for 180 min with a gamma camera. The patients injected all premeal injections of short-acting insulin through the same indwelling catheter in the following 4 days. The investigation procedure was repeated day 3 and 5. RESULTS: We found no statistically or clinically (95% CI) significant difference in residual activity of 125I-insulin after 60 min or in time for 50% of the injected depot to disappear (T-50%) among catheter injections on day 1, 3, and 5; ordinary injections on days 1, 3, and 5; or catheter and ordinary injections on days 1, 3, and 5, respectively. HbA1c correlated both to T-50% (r = 0.73, P = 0.016) and residual activity of 125I-insulin after 60 min (r = 0.69, P = 0.028), indicating that patients with a slower absorption will have a less ideal metabolic control when using premeal bolus injections. CONCLUSIONS: We conclude that using indwelling subcutaneous catheters for insulin injections for up to 4 days does not affect the absorption of short-acting insulin.

Absorption↗
PubMedDate not supplied

Absorption kinetics and biologic effects of subcutaneously injected insulin preparations.

This paper describes systematic studies on the absorption kinetics of exogenous insulin from its subcutaneous tissue depot in 52 male nonobese volunteers (age 20-30 yr). Five experimental protocols were used: effect of changing injection site, effect of temperature change and local massage, effect of aprotinin and human serum, effect of mixing regular insulin with long-acting insulin preparations, and effect of temperature change, muscular exercise, and local massage on the absorption of long-acting insulin preparations. The fastest absorption of insulin occurred at the abdominal injection. Absorption after arm injection was faster than after thigh injection. A hot bath and local massage dramatically increased serum insulin levels in the first 90 min after injection; in contrast, a cold bath delayed absorption substantially. Both aprotinin and the subjects' own blood serum mixed with insulin caused a marked acceleration of the insulin absorption process. Absorption kinetics of two neutral regular insulins (Actrapid and Leo Regular) were virtually identical. Mixing Actrapid with Monotard caused higher serum insulin levels than the mixture of Leo Regular with NPH. A time lag of 5 min between the mixing of Actrapid and Monotard and the injection caused a delayed rise of serum insulin levels; in contrast, this delay could not be observed when Leo Regular and NPH were mixed. Volunteers performed bicycle exercise, applied a hot water bottle to the injection site, or rubbed the injection site 2 1/2 h after injection of long-acting insulin. Accelerated absorption of insulin was only observed after local massage of the injection site of Monotard, Leo NPH, and Mixtard. Local heat had no effect. Exercise caused only an increased absorption of insulin after the Mixtard injection but not after Monotard or NPH injection. These findings have clinical significance and should not be without potential benefit in the attempt to improve metabolic control in insulin-treated diabetic patients.

Adult↗
PubMed2004

Inhibition of intrafollicular PGE2 synthesis and ovulation following ultrasound-mediated intrafollicular injection of the selective cyclooxygenase-2 inhibitor NS-398 in cattle.

Ultrasound-mediated intrafollicular injection and aspiration procedures were used to investigate the ability of the selective cyclooxygenase-2 inhibitor, NS-398, to inhibit intrafollicular PGE2 synthesis and suppress ovulation in dairy cattle. Follicular growth and timing of the preovulatory gonadotropin surge were synchronized in 55 Holstein cows and the position of the ovulatory follicle was determined by daily ultrasound scanning. Preovulatory follicular fluid was aspirated from the largest follicle in four animals at 0, 6, 12, 18, and 24 h after GnRH injection (n = 20). The remaining 35 animals were subjected to ultrasound-mediated intrafollicular injection of NS-398 (10 microM final concentration; n = 19) or diluent (n = 16; controls). At 24 h after GnRH injection, follicular fluid was harvested from a subset of NS-398- (n = 9) and diluent-treated animals (n = 6). The remaining NS-398- and diluent-treated animals were subjected to ultrasonography every 6 h for 36 h after intrafollicular injection, and then daily through d 7 of the subsequent luteal phase to monitor ovulation and corpus luteum development. Follicular fluid PGE2 concentrations were increased following GnRH injection and reached a maximum at 24 h (P < 0.05). Follicular fluid PGE2 concentrations were decreased in NS-398- vs. diluent-treated follicles (7.2 vs. 52.2 ng/mL respectively; P < 0.05), but progesterone concentrations did not differ. Intrafollicular injection of NS-398 also inhibited follicle rupture (P < 0.001). All 10 control animals ovulated within 30 h of GnRH injection. Nine out of the ten NS-398-injected animals failed to ovulate. The NS-398-injected follicles developed morphological and endocrine characteristics resembling luteinized, unruptured follicles. Thus, intrafollicular PGE2 synthesis and follicle rupture, but not luteinization, were inhibited in cattle following ultrasound-mediated intrafollicular injection of NS-398. Ultrasound-mediated intrafollicular injection of NS-398 is a useful tool for mechanistic studies of intrafollicular regulation of the ovulatory process in cattle.

Animals↗
PubMed1987

Stimulation of in vitro muscle cell proliferation by sera from swine injected with porcine growth hormone.

The proliferation-promoting activity of sera obtained from pigs before and after porcine growth hormone injections was tested in a muscle cell culture bioassay. For 3 d, purified porcine growth hormone (pGH) was administered by intramuscular injection to crossbred barrows. Two levels of pGH were administered: 18 micrograms pGH X kg-1 body weight X d-1 (low dose) or 143 micrograms pGH X kg-1 body weight X d-1 (high dose). Multiple blood samples were withdrawn from jugular catheters for 3 d prior to the injection, during the injection period and for 6 d after the last injection. Although serum pGH levels in low-dose pigs were raised from two to three times pre-injection levels, there was no significant change in serum proliferation-promoting activity or somatomedin-C (SmC), insulin or cortisol levels during or after administration of pGH. In contrast, the proliferation-promoting activity of sera obtained during and after the high-dose pGH injections was higher (P less than .005) than the pre-injection levels. Serum pGH levels were increased approximately 30-fold by 4 h after each injection, and increases in SmC levels were observed 10 to 16 h after the pGH injection. During the injection period SmC levels increased from 1.7 to 4 times pre-injection levels. Insulin and cortisol levels did not change significantly during the 3-d treatment period. We believe that this muscle cell culture bioassay system will be a useful addition to traditional radioimmunoassays and whole animal studies in elucidating the mode of action of pGH in pituitary-intact swine.

Animals↗
PubMed1999

[Fundamental and clinical consideration of repeated intracordal injection therapy of atelocollagen--a histological study of canine vocal cords and a review of clinical data of 96 patients].

Hoarseness or aspiration due to recurrent laryngeal nerve paralysis confront many patients with problems in their daily living. At our outpatient clinic, patients with unilateral laryngeal paralysis due to recurrent laryngeal nerve paralysis are treated by injecting atelocollagen (3% non crosslinked atelocollagen, Koken Co., Ltd.) into the vocal cords under endoscopic control, using a soft fiberscope. A single injection may not be effective, but a relatively satisfactory therapeutic result can be obtained after several repeated injections. In the present study, the tissue levels of atelocollagen in the vocal cords of 8 adult dogs were determined after intracordal injection to evaluate the efficacy of repeated injection therapy of atelocollagen. In addition, clinical data of 96 patients who were treated by this therapy at our outpatient clinic (57 males and 39 females with a mean age of 54.5 years) were assessed. Histological investigation indicated that relatively good amounts of atelocollagen were retained and accumulated in the vocal cord tissue after repeated injection, and that the tissue around the injection site showed no appreciable foreign body reaction. The clinical data showed that about half of the 96 patients had received repeated intracordal injection therapy of atelocollagen. Maximum phonation time (MPT) was determined in 75 of 96 patients. The preoperative mean MPT was 3.27 sec, whereas MPT after a single injection and after all injections increased to 6.67 and 7.16 sec, respectively. The difference was statistically significant (p < 0.001), as assessed by the paired t-test. The results of this study indicate that besides being beneficial in accidents that result in recurrent laryngeal nerve paralysis, injection therapy with atelocollagen is of clinical value because the patient can receive repeated injections under endoscopic control at the outpatient clinic at reasonable intervals of time, and thus makes the therapy more convenient.

Adolescent↗
PubMed2004

[Histological study on the effects of ethanol injection on mouth mucosa contraction loss].

We previously reported that a loss of contraction in the mucosal tissue of the palate arch is effectively induced by ethanol injections of moderate concentration and dosage. The present study was performed to obtain more information on how such ethanol injections induce contraction loss in mucosa tissue. Guinea pigs of both sexes were used in this study. The left arch of the palate mucosa was injected with 2 microliters of 70% ethanol and used as the experimental group. The right arch of the palate mucosa of the same animal was injected with saline and used as a control. One, three, five, eight, 10, 30, 50, and 90 days after injection, the mucosal tissues that received the injection were resected under anesthesia and processed for light microscopy using standard procedures. One day after the ethanol injection, severe coagulative degeneration of the mucosal tissue of the palate was seen. However, the damaged area was strictly restricted to the arch of the palate. Coagulative degeneration of the tissue peaked three days after the injection. Thereafter, the mucosal epithelial and mucosal connective tissues regenerated, and the damaged mucosal tissue quickly began to repair. An apparent cicatricial contraction loss was observed 10 days after the ethanol injection, along with the progression of fibrotic changes in the submucosal connective tissue of the arch of the palate. The regenerative action of the mucosal arch of the palate abated 30 days after the ethanol injection, and the reduced mucosal tissue appeared to have become denser as a result of an increase in dense fibrous connective tissue in the submucosal layer. No cell malignancies were seen throughout the entire 90-day observation period. In conclusion, cicatricial contraction loss of the mucosal arch of the palate resulting from the injection of an appropriate concentration and dosage of ethanol leads to the regeneration of the mucosal epithelium and fibrotic changes in the submucosa. The ethanol injection described here seems to be extremely safe, since it exerted no malignant effects on the cells and tissues either morphologically or functionally.

Animals↗
PubMed1998

Feasibility of prescribing injectable heroin and methadone to opiate-dependent drug users: associated health gains and harm reductions.

OBJECTIVE: To assess the feasibility of offering the choice of prescribing injectable heroin (diamorphine) or injectable methadone to opiate-dependent injecting drug users and to assess whether there are health and social gains associated with prescribing injectable opiates. DESIGN: A protocol-driven prospective observational study. Type of injectable opiate received was based on self-selection. SETTING: A large west London drug clinic. PATIENTS: Fifty-eight patients admitted to the clinic between 1 June 1995 and 31 December 1996, who were long term opiate-dependent injecting drug users, who had previously tried and failed oral methadone and who were apparently unable or unwilling to give up injecting. MAIN OUTCOME MEASURES: Retention in treatment, illicit drug use, HIV risk behaviour, criminal activity, social functioning, health and psychological status as measured by self-report, urinalysis and doctor's ratings. RESULTS: Thirty-seven patients (64%) chose heroin and 21 (36%) chose injectable methadone. Fifty (86%) were retained in treatment after three months, 40 (69%) after six months and 33 (57%) after 12 months. Among those in treatment at three months, there were significant reductions in illicit drug use, illicit drug-injecting risk behaviour, and criminal activity, and significant improvements in social functioning, health status and psychological adjustment. Generally, these gains were sustained between three, six and 12 months. Doctors' ratings of health and urinalysis results further supported these findings. CONCLUSIONS: Injectable heroin is not always the drug of choice. This intervention retained most patients in treatment with substantial benefits to both patients and the community. Prescribing injectable opiates to long term injecting drug users is a feasible treatment option.

Adult↗
PubMed1999

Transmission of hepatitis B, hepatitis C and human immunodeficiency viruses through unsafe injections in the developing world: model-based regional estimates.

Thousands of millions of injections are delivered every year in developing countries, many of them unsafe, and the transmission of certain bloodborne pathogens via this route is thought to be a major public health problem. In this article we report global and regional estimates of the number of hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections that may occur from unsafe injections in the developing world. The estimates were determined using quantitative data on unsafe injection practices, transmission efficiency and disease burden of HBV, HCV and HIV and the prevalence of injection use obtained from a review of the literature. A simple mass-action model was used consisting of a generalized linear equation with variables accounting for the prevalence of a pathogen in a population, susceptibility of a population, transmission efficiency of the pathogen, proportion of injections that are unsafe, and the number of injections received. The model was applied to world census data to generate conservative estimates of incidence of transmission of bloodborne pathogens that may be attributable to unsafe injections. The model suggests that approximately 8-16 million HBV, 2.3-4.7 million HCV and 80,000-160,000 HIV infections may result every year from unsafe injections. The estimated range for HBV infections is in accordance with several epidemiological studies that attributed at least 20% of all new HBV infections to unsafe injections in developing countries. Our results suggest that unsafe injections may lead to a high number of infections with bloodborne pathogens. A major initiative is therefore needed to improve injection safety and decrease injection overuse in many countries.

Cross Infection↗
PubMed2000

Unsafe injections and the transmission of hepatitis B and C in a periurban community in Pakistan.

Following reports of frequent deaths associated with jaundice and chronic liver disease among adults in a periurban community of Karachi, Pakistan, an investigation was conducted to evaluate the relationship between injections and viral hepatitis infections, to identify the reasons why patients received frequent injections, and to observe the injection practices employed in clinics. Two hundred and three adult patients were interviewed as they left each of the 18 area clinics. Practitioners were interviewed and three consecutive injections were observed at each clinic. Eighty-one per cent of patients received an injection on the day of the interview. Of the 135 patients who provided a serum sample, 59 (44%) had antibodies against hepatitis C virus and 26 (19%) had antibodies against hepatitis B virus. Patients who received more injections were more likely to be infected with hepatitis C. If oral and injected medications were equally effective, 44% of patients preferred injected medication. None of the practitioners knew that hepatitis C could be transmitted by injections. Non-sterile syringes and needles that had been used earlier in the day on other patients were used for 94% of the observed injections. Interventions to limit injections to those which are safe and clinically indicated are needed to prevent injection-associated infections in Pakistan and other low-income countries.

Adult↗
PubMed2001

Reproducibility of lymphoscintigraphy in cutaneous melanoma: can we accurately detect the sentinel lymph node by expanding the tracer injection distance from the tumor site?

UNLABELLED: The aim of the study was to determine whether the sentinel lymph node (SLN) can be accurately detected in cutaneous melanoma patients when the injection distance from the tumor site is expanded. METHODS: In 100 patients with cutaneous melanoma, lymphoscintigraphy was performed twice. First, we injected 37 MBq (99m)Tc nanocolloid intracutaneously at a 2- to 5-mm distance from either the melanoma or the biopsy scar. The injection was followed by dynamic imaging, which continued until the SLN became visible. On another day, we repeated the investigation, injecting the radiopharmaceutical intracutaneously exactly 10 mm from the previous injection site. The detected SLNs of both investigations were compared to determine the number and location of SLNs for each patient. RESULTS: The SLN identification rate was 94% with close injection and 100% with 10-mm-distant injection. All SLNs detected with close injection were visible with distant injection. In 84 of 100 patients, the images of both investigations showed the same number and location of SLNs. In the remaining 16 patients, an additional SLN was detected with the distant injection. CONCLUSION: The reproducibility of lymphoscintigraphy using different injection distances was 84%. The discordance in the remaining 16% was caused by detection of a lymph node in addition to the original SLN with distant injection. Diagnostic excision of the primary tumor before lymphoscintigraphy was possible without preventing detection of the original SLN. However, in 16% of our patients, excision of an additional lymph node had to be considered when lymphoscintigraphy was performed after diagnostic excision.

Adult↗
PubMed2001

The effects of intraocular injection of interleukin-13 on endotoxin-induced uveitis in rats.

PURPOSE: Interleukin (IL)-13 is a strong immunomodulatory cytokine that inhibits macrophages from secreting proinflammatory mediators. This study was conducted to investigate the effect of intraocular injection of IL-13 on the development of endotoxin-induced uveitis (EIU) in the Lewis rat. METHODS: One injection into the anterior chamber of recombinant human IL-13 (6 ng in 10 microl saline) was performed either simultaneously with a single injection of lipopolysaccharide (LPS) from Salmonella typhimurium into the footpad or 6 hours before the IL-13 injection. EIU was evaluated by slit lamp examination at 6, 16, and 24 hours after LPS injection. Counts of inflammatory cells were performed on cryostat sections after specific immunostaining. Anterior chamber paracentesis was performed, and kinetic analysis of the IL-13 injected in the anterior chamber was performed by ELISA. Cytokine and chemokine gene expression in the iris-ciliary body and the retina was evaluated by reverse transcription-polymerase chain reaction. RESULTS: A significant inhibition of ocular inflammation was observed in IL-13-treated rats at 16 and 24 hours after LPS injection. Unilateral injection of IL-13 inhibited EIU only in the injected eye. High levels of IL-13 were detected in the aqueous humor at 2 hours after local IL-13 injection to remain high up to 18 hours. In contrast, IL-13 was not detected in the corresponding sera. Quantitative analysis of inflammatory cells in ocular tissues showed a significant decrease in OX-42(+) cells (microglia, activated macrophages, dendritic cells, and polymorphonuclear leukocytes) and ED1(+) cells (monocytes-macrophages and dendritic cells) in treated rats. A decreased expression of TNF-alpha, IL-1 beta, IL-6, monocyte chemoattractant protein (MCP)-1, and macrophage inflammatory protein (MIP)-2 mRNAs was observed in the iris-ciliary body and the retina from IL-13-treated rats, whereas IFN-gamma was upregulated in the iris-ciliary body. CONCLUSIONS: Injection of IL-13 into the anterior chamber may inhibit the ocular inflammation induced by LPS injection by reducing intraocular cytokine and chemokine mRNA expression in ocular tissues.

Animals↗
PubMed2001

[The role of neuroimmunoregulation mobilized by enhancing immunologic function via hou hai acupoint antigen injection].

OBJECTIVE: To study the mechanism of neuroimmunoregulation which is triggered by enhancing immunologic function via Hou Hai acupoint antigen injection. METHODS: Immunohistochemical method, immunofluorometric method and RT-PCR were used to examine the different distribution of cytokine immunopositive cells in the brain and expression of cytokines in the spleen of the human IgG sensitized rats received acupoint, subcutaneous and normal rats antigen injections. RESULTS: In the areas of lateral hypothalamic nucleus (LH) and amygdaloid nuclear complex (AA), the distribution of cytokines immunopositive cells with acupoint injection group was significantly increased more than that in the subcutaneous injection group. But the expression of cytokines immunopositive cells both by the acupoint injection and the subcutaneous injection groups reached their peak value in similar time. Double-labelling results showed that the cytokine immunopositive cells were neurons. In the spleens, the expressions of cytokines, IL-2 and IFN, were significantly increased by acupoint injection more than subcutaneous injection. CONCLUSIONS: The time course of neuroimmunoregulation is similar in the immunized rats via both acupoint injection and subcutaneous injection of antigens. But the activity of neuroimmunoregulation is not the same in acupoint and subcutaneous injection groups. Neurons of the LH and AA are the main source of the neuroimmunomodulators. The effect of enhancing immunologic function via Hou Hai acupoint injection is may be more efficient to mobilize the activity of neuroimmunoregulation of immune-associated brain region than modulation of the immune system.

Acupuncture Points↗