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Coronary artery injection technique: a quantitative in vivo investigation using modern catheters.

To date, there have been no quantitative in vivo assessments of contrast volumes and injection rates using modern high flow catheters during coronary angiography. Contrast volumes (n = 554), injection durations (n = 563), and injection rates (n = 498) were collected during 88 cardiac catheterizations. With increasing cathetersize (6, 7, and 8 French), injection volume increased (P < 0.0001), duration decreased (P < 0.0001), and rate increased (P < 0.0001). Compared with injections into the right coronary artery, left coronary artery injections were larger (7.1 +/- 0.1 cc vs. 4.8 +/- 0.1 cc, p < 0.0001), longer (3.6 +/- 0.05 sec vs 3.0 +/- 0.07 sec, P < 0.0001) and faster (2.1 +/- 0.04 cc/sec vs. 1.7 +/- 0.06 cc/sec, P < 0.0001). Patients with a significant stenosis in the left main or proximal right coronary artery received less contrast (P < 0.0001) more slowly (P < 0.0001) over a similar duration of injection (P = NS). When collaterals arose from the injected artery, angiographers injected more contrast (P < 0.001) over a longer period (P < 0.0001) more slowly (P < 0.0001). Catheter size and the injected vessel's location and anatomy significantly affect coronary catheterization injection technique.

Angioplasty, Balloon, Coronary↗

Intra-tumoral injection of doxorubicin (adriamycin) encapsulated in liposome inhibits tumor growth, prolongs survival time and is not associated with local or systemic side effects.

Encapsulation of doxorubicin (Adriamycin) in liposome (LipADM) augments the anti-tumor effects of the drug and reduces side effects such as cardiotoxicity. However, it does not always enhance anti-tumor effects because of entrapment by the reticuloendothelial system. In this study, we investigated the anti-tumor effect of LipADM injected directly into the tumor to augment tumor targeting. LipADM (7.5 mg/kg body weight), the same concentration as free ADM (FADM), was injected percutaneously or i.v. into 7-day-old established Meth-A tumors in mice. Mock liposome was injected percutaneously into tumors of control mice. Mean relative tumor weights of the 5 groups on day 15 were as follows: intra-tumoral injection of LipADM, 2.92 +/- 1.09; intra-tumoral injection of FADM, 6.99 +/- 2.92; i.v. injection of LipADM, 11.07 +/- 7.95; i.v. injection of FADM, 11.80 +/- 6.55; control, 23.94 +/- 9.03. Mean survival times were as follows: intra-tumoral injection of LipADM, 46.2 +/- 11.0 days; FADM, 34.6 +/- 9.6 days; mock control, 30.2 +/- 4.8 days. Histological examination showed no tissue damage at the site of s.c. injection of LipADM. ADM concentrations in tumor tissues after intra-tumoral injection were persistently high in the LipADM-treated group. Our results indicate that direct injection of LipADM into the tumor is therapeutically useful by producing persistently high concentrations of ADM in the target tissue, with few local and systemic side effects.

Animals↗

Periurethral injection therapy for urinary incontinence in women.

BACKGROUND: Stress urinary incontinence is a common, troublesome symptom amongst adult women. Periurethral injection of bulking agents is a surgical procedure used for the treatment of urinary incontinence. OBJECTIVES: To assess the effects of periurethral injection therapy in the treatment of urinary incontinence in women. SEARCH STRATEGY: We searched the Cochrane Incontinence Group trials register (February 2003), MEDLINE (January 1996 to January 2003), PREMEDLINE (7 February 2003) and the reference lists of relevant articles. Date of the most recent searches: February 2003. SELECTION CRITERIA: All randomised or quasi-randomised controlled trials of treatment for urinary incontinence, in which at least one management arm involved periurethral injection therapy. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed methodological quality of each study using explicit criteria. Data extraction was undertaken independently using a standard form and clarification concerning possible unreported data sought directly from the investigators. MAIN RESULTS: We identified seven trials that met the inclusion criteria. The limited data available prevented meta-analysis. Injection of autologous fat was compared to placebo in a study of 68 women which was terminated early because of safety concerns. No differences in subjective or objective outcome were found in the two groups. No studies were found comparing injection therapy with conservative treatment. The single study that compared injection with a variety of surgical management in 133 women found no significant difference in subjective outcome but did note significantly better objective outcome in the surgical group. The four studies that compared different agents found that silicone particles and carbon spheres gave improvement at 12 months equivalent to collagen. A comparison of paraurethral and transurethral methods of delivery of the bulking agent found similar outcome but a higher rate of early complications in the paraurethral group. REVIEWER'S CONCLUSIONS: Data from the available randomised trials suggest, but do not prove, that periurethral injection of established manufactured bulking agents results in subjective and objective short term improvement of symptomatic female stress urinary incontinence in adults. Future recommendation as a first line treatment would require evidence of patient benefit and cost-effectiveness from randomised trials involving placebo and conservative treatment arms. Future studies should also record long-term outcome and monitor for delayed particle migration. Injection therapy is probably inferior to surgery but a long term comparative study against a single standard procedure (Burch colposuspension) is required to prove this. It is recommended that phase III studies of newer agents will not be worthwhile until the aforementioned trials have been performed and a rationale for the use of injection therapy decided. For women with extensive co-morbidity precluding anaesthesia, injection therapy may represent a useful option for relief of symptoms for a 12 month period although 2 or 3 injections are likely to be required to achieve a satisfactory result.

Biocompatible Materials↗

Pharmacokinetic study of methotrexate following intra-articular injection of methotrexate loaded poly(L-lactic acid) microspheres in rabbits.

The pharmacokinetics and tissue distribution of methotrexate (MTX) were investigated following intra-articular injection of either MTX solution or controlled release MTX loaded microspheres in healthy rabbit joints. MTX solution or MTX loaded microspheres (size 30-100 mum) (10 mg MTX) was injected into the right knee joint cavity of rabbits. Blood samples were taken at predetermined times from the jugular vein. Urine samples were also collected over time periods up to 24 h. The major organs and synovial tissues were removed for analysis 6 and 24 h post-injection (n = 4). MTX and 7-OH-MTX concentrations in the plasma and major organs were determined by HPLC. The MTX plasma area under the concentration-time curve (AUC) for rabbits injected with MTX solution was seven fold higher than that of the rabbits injected with MTX microspheres, while t(1/2) and mean residence time (MRT) were not significantly different between two treatment groups. Four fold more MTX was excreted in the urine from rabbits injected with MTX solution compared to those injected with MTX loaded microspheres 24 h following intra-articular injection. The concentration of MTX in the synovial tissues following intra-articular injection was significantly higher in the rabbits injected with microspheres than in the rabbits injected with MTX solution. MTX solution was rapidly cleared from the joint cavity while MTX encapsulated microspheres retained MTX in the joint cavity.

Alanine Transaminase↗

Intradermal injection of autologous dermal fibroblasts improves wound healing in irradiated skin.

BACKGROUND: Despite its well-recognized benefits in the management of several solid tumors, the use of radiotherapy prior to surgery is associated with a high incidence of significant surgical wound healing complications. Radiation-induced damage to dermal fibroblasts has been proposed as an important cause. We hypothesized that the introduction of normal, unirradiated fibroblasts into previously irradiated skin would enhance healing of the subsequent surgical wound. MATERIALS AND METHODS: Four groups of wounds were examined in female Wistar rats: (1) unirradiated skin (n = 10), (2) irradiated skin injected with tissue culture medium alone (n = 17), (3) irradiated skin injected with autologous dermal fibroblasts (n = 17), and (4) irradiated skin injected with irradiated autologous dermal fibroblasts (n = 7). Wounds were evaluated biomechanically and histologically. RESULTS: The biomechanical values of breaking load, ultimate tensile strength, elastic modulus, and toughness were significantly greater in the irradiated wounds injected with fibroblasts than those injected with medium only. These cell-injected wounds did not perform as well biomechanically as those in unirradiated skin. Irradiating the cells prior to injection resulted in biomechanical results no better than those in medium-injected wounds. CONCLUSIONS: These results demonstrate that injection of normal, unirradiated fibroblasts significantly improves healing of the irradiated surgical wound. These cells are likely better able to respond to the proliferative, migratory, and synthetic demands of the wound healing environment, as injection of irradiated cells has an equivalent effect on healing as injection of medium alone.

Animals↗

Synaptic mechanisms acting on lumbar motoneurons during postural augmentation induced by serotonin injection into the rostral pontine reticular formation in decerebrate cats.

Intrapontine microinjections of serotonin in acutely decerebrated cats resulted in the bilateral augmentation of the postural muscle tone of the hindlimbs. Optimal injection sites were located in the dorsomedial part of the rostral pontine reticular formation corresponding to the nucleus reticularis pontis oralis (NRPo). In this study, attempts were made to elucidate the cellular basis for the serotoninergically induced augmentation of postural muscle tone by recording the electromyographic (EMG) activity of hindlimb extensor muscles, the monosynaptic reflex responses evoked by electrical stimulation of group Ia muscle afferent fibres and the membrane potentials of hindlimb alpha-motoneurons (MNs). Serotonin injections resulted not only in the augmentation of the EMG activity of gastrocnemius soleus muscles, but also in the restoration of EMG suppression, which was induced by previous injection of carbachol into the NRPo. Extensor and flexor monosynaptic reflex responses were facilitated by serotonin injections into the NRPo. Such reflex facilitation was not induced by serotonin injections into the mesencephalic or the medullary reticular formation. Intrapontine serotonin injections resulted in membrane depolarization of extensor and flexor MNs with decreases in input resistance and rheobase. Spontaneous depolarizing synaptic potentials (EPSPs) increased in both frequency and amplitude. Peak voltage of Ia monosynaptic EPSPs also increased. Serotonin injections which followed carbachol injections resulted in membrane depolarization of MNs along with an increase in the frequency of spontaneous EPSPs and a decrease in carbachol-induced inhibitory postsynaptic potentials. Following pontine carbachol injections, antidromic and orthodromic responses in MNs were suppressed. Discharges of MNs evoked by intracellular current injections were also suppressed, but were restored following serotonin injections. These results indicate that postsynaptic excitation, presynaptic facilitation and disinhibition (withdrawal of postsynaptic inhibition) simultaneously act on the hindlimb MNs during serotonin-induced postural augmentation and restoration.

Animals↗

Histopathological effects of intracerebral injections of human recombinant tumor necrosis factor-alpha in the rat.

Human recombinant tumor necrosis factor-alpha (rTNF-alpha) was administered to normal Fischer 344 rats by stereotaxic intracerebral (IC) injection. Animals received a single injection of either 6 x 10(4) U rTNF-alpha or excipient in their right parietal lobe. Others received three consecutive daily injections of either 6 x 10(4) U rTNF-alpha or excipient to examine effects of higher accumulative doses. Histological examination of the brain revealed that both single and multiple IC injections of rTNF-alpha triggered an immigration of circulating leukocytes into the site of TNF-alpha injection. After one injection, this cell population was composed mainly of macrophages and neutrophils. Maximal leukocytic influx occurred by 48 h and was composed mostly of neutrophils which were limited to the injection site and perivascular space. Quantitation of the inflammatory reaction by measurement of tissue myeloperoxidase levels supported these histological observations. One day after multiple rTNF-alpha injections, leukocytic adhesion to endothelium, vascular cuffing and leukocytic infiltration into the neuropil was observed at levels comparable to those seen 3 days following a single rTNF-alpha injection. We conclude that while one or more IC injection(s) of 6 x 10(4) U rTNF-alpha was well tolerated in normal rats, at this dose the cytokine triggers a pronounced leukocytic infiltration at the site of injection. These results support a role for TNF-alpha as a mediator in inflammatory responses within the central nervous system.

Animals↗

[Standardized fluorescein injection in serial angiography (author's transl)].

Maximal initial dye concentration in the retinal arteries is desirable for high quality fluorescein Angiograms and is essential for circulation studies. Such high initial dye concentrations can only be achieved by a very rapid fluorescein injection technique necessitating an automatic injector. A reliable easy to use "spring-injector" has been designed for clinical use (Figs. 1 and 2). A disposable syringe is driven by a spring contained in a metal cylinder. Microswitches are activated by the piston of the injector triggering one exposure each at the beginning and at the end of the injection. Time and duration of the injection are therby permanently documented on the film. The "Terumo Disposable Syringe 10 cc" is used routinely. By interposing a plastic connector between syringe and injector-piston the injection-volume can be reduced to 5 ml. With diffferent connectors one can inject an volume desired up to 10 ml. The duration of the injection can be varied by using different intravenous catheters. Routinely the "VYGON Trocaflex catheter Nr. 125.16" with a needle diameter of 1.1 mm and a length of 30 cm is used resulting in an injection time of 10 ml/1.0 sec or 5 ml/0.5 sec. The largest Trocaflex catheter (No. 125.20) will shorten the injection time to 10 ml/0.5 sec and 5 ml/0.25 sec respectively. Even faster injections can be achieved by shortening the catheter or by using a stronger spring. With the described injector, high-speed, well-standardized fluorescein injections are possible. The intravenous catheter makes parvenous injections impossible and will allow for repeated angiograms even on different days without the need for a new venous puncture.

Fluorescein Angiography↗

Lumbar epidural perineural injection: a new technique.

Two controlled studies for a new epidural, perineural, single-shot, selective nerve root injection with a double-needle approach to the anterior epidural space of the lumbar spinal canal are presented. The results were analysed to determine the effectiveness of the new epidural perineural injection technique. The trial comprised two controlled studies on 182 patients. One study compared prospectively randomized results of patients with lumbar radicular syndromes who received epidural perineural injections (n = 47), conventional posterior epidural injections (n = 40) and, as a control group, paravertebral local anaesthetic (n = 46). A second, prospective, double-blind study compared the effect of epidural perineural injections with triamcinolone (n = 24) and pure saline (n = 25). Epidural perineural injections were more effective than conventional posterior epidural injections. Both epidural groups had better results than the paravertebral local injection group. Epidural perineural injections with steroids (10 mg triamcinolone) were more effective than saline alone. A systemic steroid effect was excluded by additional intramuscular steroid injections in the saline group. There were no severe complications or side effects in any of the three groups. The studies concluded that single-shot epidural perineural injection is effective in the treatment of lumbar radicular pain. It is a "one drop only" therapy to the source of pain.

Double-Blind Method↗

Inhibition of amphetamine-induced locomotor activity by injection of carbachol into the anterior hypothalamic/preoptic area: pharmacological and electrophysiological studies in the rat.

The effects of carbachol injected into the anterior hypothalamic/preoptic area on locomotion initiated by intra-accumbens injections of amphetamine were investigated. Changes of locomotion following intracerebral injections were measured in an automated activity box and the mean firing rate (m.f.r.) from neurons in the mesencephalic locomotor region (MLR) recorded in parallel acute electrophysiological experiments. Amphetamine (20.0 micrograms) injected to the nucleus accumbens caused a 2.5-fold increase in locomotion of rats. Subsequently, injections of carbachol (0.5 or 1.0 microgram) into the hypothalamic/preoptic area reduced the amphetamine-induced locomotion. These effects were stronger with ipsilateral than with contralateral injections and were reversed by pretreating the hypothalamic/preoptic area with 1.5 micrograms of atropine before carbachol injection. In electrophysiological experiments, injecting carbachol into the hypothalamic/preoptic area reduced the m.f.r. of MLR neurons from 8.3 +/- 0.7 to 4.1 +/- 0.5 per s and reduced the m.f.r. of 13 of 17 MLR neurons recorded continuously before and after injection. In contrast, injecting amphetamine into the nucleus accumbens increased the m.f.r. of units from 8.3 +/- 0.7 to 12.8 +/- 1.0 per s and increased the m.f.r. of 11 of 12 MLR neurons recorded continuously before and after injection. These results suggest that the hypothalamic/preoptic area contains muscarinic cholinoceptive areas which reduce locomotor activity by direct or indirect effects on the MLR.

Amphetamine↗

Postabortal contraception with norethisterone enanthate injections.

Intramuscular injection of 200 mg norethisterone enanthate (NET-EN) was given to five women on the day of first trimester abortion. The injection was repeated twice at eight-week intervals, and thereafter at twelve-week intervals for one year. Plasma samples were collected for FSH, LH/hCG, estradiol, progesterone and norethisterone (NET) determinations. NET-EN did not affect the elimination of hCG, estradiol or progesterone. Plasma NET concentrations reached a peak (5.5-11 ng/ml) in about ten days after the injection and declined constantly thereafter, to levels of 0.18-0.64 ng/ml at 8 weeks after the injection. NET-EN postponed the increase in FSH secretion until 17-20 days after the injection, i.e. until plasma NET concentrations fell below 3 ng/ml. In three out of five women some follicular activity was present 5 weeks after NET-EN injection as evidenced by increased plasma estradiol concentrations. No ovulation occurred within 8 weeks after NET-EN injection, as judged by low progesterone values. There was a definite accumulation of NET during the first six months, when NET-EN injections were given at eight-week intervals. Mean plasma NET concentrations increased from 0.34 ng/ml at eight weeks to 0.78 ng/ml at 24 weeks. When the injection interval was increased to twelve weeks, the plasma NET concentrations prior to the next injection started to decrease. This was accompanied by increased follicular activity, culminating with one ovulation observed. It is concluded that in this population of women, an injection interval of less than twelve weeks is needed for ovulation inhibition.

Abortion, Legal↗

Intraperitoneal injection of chloral hydrate causes intra-abdominal adhesions and unilateral testicular atrophy in golden Syrian hamsters.

We investigated the reason for the high mortality we had observed in hypophysectomized-orchidectomized Golden Syrian hamsters that were anesthetized with intraperitoneal (i.p.) injections of chloral hydrate (CH). Intact male Golden Syrian hamsters were injected intraperitoneally with 0.1cc/100g BW of a 35% solution of CH, a 35% solution of sodium chloride, or double-distilled water. Equal numbers of hamsters in each group were injected on the right or left side of the abdomen. Within 10 days, 35% of the CH-injected hamsters were dead or had to be euthanized. Autopsy revealed severe peritonitis and adynamic ileus. CH-injected hamsters that survived gained weight at a rate similar to that of the controls. All surviving hamsters were killed 18 days after the injections. Among the surviving CH-injected hamsters, 84.6% had intra-abdominal adhesions, 61.5% had unilateral testicular atrophy, and 53.8% had a yellowish necrotic mass in the epididymal fat pad (EFP). All the lesions occurred on the side that was injected. The atrophied testes had been rendered cryptorchid due to involvement with intra-abdominal adhesions. In the water-treated controls, there were no abnormalities; whereas, in the saline controls, 75% had a mass in the EFP. Histology of the EFP mass was similar in hamsters injected with CH or hypertonic saline and suggested a diagnosis of fat necrosis. The results suggest that the mortality, the intra-abdominal adhesions, and the unilateral cryptorchidism were caused by a single i.p. injection of CH, but the fat necrosis in the EFP was probably caused by high concentrations of salt. The results further suggest that high concentrations of CH should not be injected intraperitoneally for anesthesia in chronic studies, particularly of the male reproductive system.

Adipose Tissue↗

Arthritis induced by interleukin-1 is dependent on the site and frequency of intraarticular injection.

Intraarticular injection of recombinant human interleukin-1 (IL-1) in rats resulted in varying degrees of inflammatory changes depending on the site and frequency of injections. (i) Much lower amounts of IL-1 were required to elicit an inflammatory response in the ankle joints (15-3000 ng) than the knee joints (90-150 micrograms). (ii) The inflammatory response was much greater if IL-1 was administered in multiple doses as compared to a single dose injection. One day after a single injection of IL-1 (90-150 micrograms), knee joints exhibited a mild increase in volume as a consequence of edema, but at the end of 1 week, no discernible change in volume was observed. However, when the same total amount of IL-1 was injected in three doses, there was a dramatic increase in joint volume at the end of 1 week that persisted for at least 3 weeks. The increase was dose dependent. (iii) The inflammatory response was dependent on the age/weight of the rats: the older the animals the greater the response. (iv) Under conditions where IL-1 induced inflammatory changes in knee joints, recombinant tumor necrosis factor failed to induce any significant response. (v) Histological examination of the knee joints revealed distinct differences in the pathological response to the two different protocols of IL-1 administration in the knee joints. The animals injected with a single dose of IL-1 showed a mild and transient inflammation that was resolved by 2 weeks postinjection, but exhibited degenerative changes associated with focal loss of chondrocytes and proteoglycan of the knee joint cartilage, which became progressively severe. The knee joints of animals given three injections of IL-1 showed evidence of marked acute synovitis, fibroplasia, loss of proteoglycan and chondrocytes, resorption of subchondral bone, and transition of hematopoeitic marrow cells into cells of mesenchymal morphology. (vi) Examination of proteoglycan synthesis by cartilage of IL-1-injected rats revealed that within 1 day after injection, a dramatic reduction in synthesis occurred which persisted for at least 2 weeks. These studies suggest that intraarticular injection of IL-1 provides a useful rodent model for the investigation of pathological changes occurring within a localized joint as a result of acute and chronic inflammatory stimuli. Relevant aspects of the pathology of joint erosion can be demonstrated depending on the frequency of IL-1 injection.

Aging↗

Control of behavior by intravenous nicotine injections in laboratory animals.

A series of recent studies are reviewed which demonstrate that behavior can be controlled by nicotine injections in different ways depending on the behavioral history of the subject and the schedule of reinforcement under which nicotine is administered. Lever-pressing responses by squirrel monkeys and beagle dogs were maintained well above saline-substitution levels by injections of 10 to 30 micrograms/kg of nicotine under fixed-ratio schedules of nicotine injection. Lever-pressing responses by squirrel monkeys also were well maintained by injections of 30 to 300 micrograms/kg of nicotine under a fixed-interval schedule of nicotine injection. The highest rates of responding were maintained by injections of 10 to 30 micrograms/kg of nicotine under second-order schedules in which responding by squirrel monkeys produced brief-light presentations which were only occasionally paired with nicotine injection. Under other conditions, however, response-produced injections of these same injection doses of nicotine (10 to 30 micrograms/kg) suppressed food-maintained fixed-ratio responding by squirrel monkeys during the punishment component of a multiple schedule. Finally, under a schedule of nicotine postponement, injection doses of 30 to 56 micrograms/kg of nicotine maintained responding that prevented, rather than produced, nicotine injections. These findings indicate that nicotine may control smoking behavior of humans in very complex and divergent ways depending on prevailing environmental conditions.

Animals↗

Intra-axonal Neurobiotin injection rapidly stains the long-range projections of identified trigeminal primary afferents in vivo: comparisons with HRP and PHA-L.

Currently available methods for studying the morphology of physiologically characterized primary afferents are limited by difficulties inherent in impaling thin fibers and by the limited distances over which conventional tracers move during the course of a recording session. We have encountered an alternative method that overcomes these limitations. Neurobiotin (NB; Vector) injections into rat trigeminal (V) primary afferents in the brain stem or V ganglion provided rapid, long-range staining with recording and electrophoretic parameters that are commonly used to eject horseradish peroxidase (HRP) or Phaseolus vulgaris leucoagglutinin (PHA-L). When NB was injected into brain stem fibers responsive to vibrissal deflection with A-beta conduction velocities, collaterals were darkly stained in each of the 4 V subnuclei, as well as the cervical dorsal horn. Labeled fibers were also seen in the V root and peripherally in the infra-orbital nerve for a distance up to 15 mm from the injection site (30 mm total). Cell bodies in the ganglion were never labeled. When NB was injected into V ganglion cells with low- or high-threshold receptive fields and A-beta or A-delta conduction velocities, parent axons were stained in the V spinal tract to the level of the obex, and collaterals were visible in each of the 4 V subnuclei. Such long-range staining occurred within 4 h of tracer injection. HRP never stained brain stem fibers following ganglion cell injections and, when injected centrally with the same survival intervals used with NB, dark staining was limited to within 4 mm of the injection site. Unlike NB or HRP, PHA-L injections rarely produced useful data, either because of the high mortality accompanying attempts to achieve a 1-2 week survival period or because injected neurons were not recovered. Due to its rapid and robust transport, NB is a more convenient and reliable tracer than PHA-L for producing long-range staining of the projections of identified ganglion cells. Intracellular injection of NB also produces rapid Golgi-like staining of fibers over much greater distances than HRP under equivalent staining parameters.

Afferent Pathways↗

Effects of intracerebral injections of VIP on jejunal alanine absorption and gastric acid secretion in rats.

The effects of intracerebral injections of VIP on jejunal alanine absorption and gastric acid secretion, and its association with vagal outflow were examined in Sprague-Dawley rats. Intracerebroventricular injection of VIP (2 ng) decreased significantly (P < 0.05) alanine absorption across the jejunum, whereas similar injections in vagotomized rats did not show further decrease in absorption beyond that noticed by vagotomy only. Moreover, VIP injected in the Nucleus Tractus Solitarius-Dorsal Motor Nucleus (NTS-DMN) complex (1 ng) produced also a significant inhibition of Ala absorption which was reduced but remained significant (P < 0.05) after vagotomy. Water movement was not affected by VIP injection in the lateral ventricle, while VIP injections in the NTS-DMN inhibited significantly (P < 0.05) jejunal water absorption by 10-12%. Vagotomy increased water absorption by 15-20% above control (P < 0.05) which was not altered by injecting VIP in the NTS-DMN complex. On the other hand, VIP injection in the NTS-DMN produced a 25.7% increase in gastric acid output in the first hour of the experiment followed by a non-significant decrease (P > 0.05) in the second hour. Same injections done in vagotomized animals produced similar effects to those elicited by vagotomy only. It can be suggested that NTS-DMN complex could be a site of action of VIP since injection of VIP in it produced a more pronounced inhibitory effect on water and Ala absorption than that produced by VIP injection in the LV. These effects were reduced or abolished by vagotomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Alanine↗

The popularity of injections in the Third World: origins and consequences for poliomyelitis.

Paralysis from poliomyelitis may follow injections yet injections are extremely popular in the Third World. Some injections are given by hospital doctors and nurses but the majority are given by traditional healers, pharmacists and paramedical workers who have acquired syringes. Many injections may be given to a sick child. I suggest that the early use of vaccines did not persuade people of the mystic of injections and that the mystic predated the use of penicillin. The earliest mystical result would have been the injection of quinine for malaria and antrypal for sleeping sickness. The words brilliant, spectacular and dramatic were first used to describe the mass campaigns against yaws and kala-azar in the 1920s and 1930s. A single injection healed the ugly lesions in a week: cause and effect were visible. In the 1950s penicillin was used in mass eradication campaigns. The countries where injections are so popular correspond roughly with the areas of mass eradication programmes. Many or perhaps most of the injections are not sterile and present a great risk of attendant paralysis. Proof that injections are causal may be impossible. Meanwhile we need to know why injections are so popular and how they can be less so.

Attitude to Health↗

Cataract progression after intravitreal triamcinolone injection.

PURPOSE: To assess cataract progression after intravitreal triamcinolone injection. DESIGN: Retrospective, interventional, case-control study. METHODS: Forty-two phakic eyes of 37 patients were injected one, two, or three times with intravitreal triamcinolone for various indications. Noninjected phakic fellow eyes served as the control. The mean follow-up time for single injection was 12 months, for multiple injections was 14 months, and for control group was 13 months. Lens status, best-corrected visual acuity, and refractive errors were recorded at baseline and at each follow-up examination. RESULTS: At the last follow-up, changes in posterior subcapsular cataract and refractive error from baseline were significantly different between single triamcinolone-injected eyes and the control group [0.7 +/- 0.2 (mean +/- SEM [arbitrary unit] vs 0.2 +/- 0.1, P = .02; and -0.5 +/- 0.1 diopter vs -0.2 +/- 0.1 diopter, P = .01, respectively). For multiple-injected eyes and control eyes, change from baseline in corticonuclear cataract (1.1 +/- 0.2 vs 0.2 +/- 0.1), posterior subcapsular cataract (1.1 +/- 0.2) and refractive error (-1.8 +/- 0.4 diopters) were significantly different (P < .001, P < .001, and P < .001, respectively). Visual acuity did not change after single injection (P = .83) and in control group (P = .19) but decreased after multiple injections (P = .006). Eleven study eyes and two control group eyes underwent cataract extraction during study period. Corticonuclear and posterior subcapsular cataract progression significantly correlated with follow-up time (P = .003 and P = .02, respectively) and number of injections (P = .01 and P = .04, respectively). CONCLUSIONS: Single intravitreal triamcinolone injection induces posterior subcapsular cataract development, whereas multiple injections result in all-layer cataract progression.

Aged↗