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PubMed2005

[Assessment of contrast enhancement using the variable contrast medium injection method in 3D-CTA of the head].

We have reported that, using the bolus-tracking method synchronized with an injector, the injection of contrast medium in a single phase up to 10 sec before the end of the study (referred to as "single-stage injection") or the combination of single-stage injection stopped 15 sec before the end of the study and a physiological saline solution flush (referred to as "saline solution flush") makes it possible to minimize the amount of contrast medium employed in 3D-CTA of the head and neck in a scanning time of approximately 30 sec. If the continuous variable method of contrast medium injection (referred to as "variable injection") can provide the same level of contrast enhancement as that obtained with a single-stage injector for constant-rate injection, it should be possible to eliminate cumbersome study procedures associated with the saline solution flush and to simplify the study protocol. We therefore performed a comparative study to assess the contrast enhancement effect in variable injection. The results showed that variable injection provided almost the same degree of contrast enhancement as single-stage injection + saline solution flush, while permitting the amount of contrast medium to be reduced. It was concluded that variable injection (with a variation parameter of 0.5) is an effective method of improving the contrast enhancement effect and minimizing the amount of contrast medium employed, as compared with the saline solution flush method. Furthermore, it permits the examination procedures to be simplified.

Angiography↗
PubMed2006

The cost of unsafe injections in pakistan and challenges for prevention program.

The burden of disease associated with unsafe therapeutic injection practices in Pakistan is very high. The number of injection per person per year has been estimated to be in the range of 8.2 to 13.6, one of the highest in developing world. Extrapolating this number to the whole country would result in 1.5 billion injections per year. Approximately 4% (75 million) of these are administered for immunization while the remainders are used for therapeutic use. Of these, 94.2% are unnecessary. Average price of an injection (not the complete prescription) is Rs. 20.6 (0.34 US dollars). Under conservative estimate, over three billion rupees or 500 million dollars out-of-pocket healthcare resources may be wasted each year. Appropriate use of injections would be highly cost effective. According to adjusted analysis, safe and appropriate use of injection in Pakistan would cost 92 million US dollars each year with a high proportion that would be injection devices paid through out-of-pocket expenses. Behaviour change for reduction in number of injections require long-term multidimentional efforts. Interventions in the form of phasing out of convention disposable injection equipment and switching to reuse prevention devices for all injections could prevent the common practice of reuse, hence reducing the transmission of infections.

Cost-Benefit Analysis↗
PubMedDate not supplied

Long-term follow-up results of vesico-ureteral reflux treated with subureteral collagen injection (SCIN).

BACKGROUND: Endoscopic sub-ureteral injection is at the present a widely used technique for the treatment of vesico-ureteral reflux and it has a good range of efficacy, from 50% up to 90% in relation to different grades. In this paper we report our 1-7 year follow-up results of sub-ureteral collagen injection (SCIN). METHODS: Between 1991 and 1997 we treated with SCIN 129 refluxing ureters in 93 children (60 females and 32 males), mean age 2.1 years (range 3 months-5 years). Fifty-five children had monolateral, but 37 had bilateral reflux. Distribution among different grades was 42 ureters (32.5%) grade 2, 63 (48.8%) grade 3, 24 (18.6%) grade 4. Children were treated with injection of highly purified bovine collagen. In this study all the children underwent radiological follow-up for evaluating the results of treatment with SCIN also in a period of time from 3 to 7 years after endoscopic procedure. RESULTS: After a 1 to 7 years follow-up period we have the following results. In grade 2 we have found absence of reflux in 36 cases (85.7%) after 1 injection and in 38 (90%) after 2 injections. In grade 3, reflux was absent on 46 cases (73%) after 1 injection and in 55 (87.3%) after 2 injections. In grade 4 reflux was cured in 16 (66.6%) after 1 injection and in 18 (75%) after 2 collagen injections, 15% of all units, underwent Cohen's reimplantation. CONCLUSIONS: After 7 years of experience we have concluded that sub-ureteral collagen injection is actually a very good procedure for treatment of mild grade refluxes. We treat these refluxing ureters only when antibiotics prophylaxis is to be prolonged over 6 months with no changes in cystourethrography findings or when recurrent urinary tract infections occur in spite of antibiotics intake. In conclusion, if we evaluate the overall results we see that 73.6% of refluxing ureters have been cured by SCIN, the rate of recurrence is 16.8% and the 15.5% finally underwent Cohen's reimplantation.

Biocompatible Materials↗
PubMedDate not supplied

Percutaneous ethanol injection for hepatocellular carcinoma originating in the caudate lobe.

BACKGROUND/AIMS: Hepatocellular carcinoma originating in the caudate lobe is rare and the treatments for caudate hepatocellular carcinoma were thought difficult, because of its unique location at hepatic resection, or because of complex arterial supply at transcatheter arterial embolization. Percutaneous ethanol injection is an effective treatment for small hepatocellular carcinoma. The aim of this study was to assess the efficacy of percutaneous ethanol injection for hepatocellular carcinoma originating in the caudate lobe. METHODOLOGY: During the past 4 years, 7 patients with 7 hepatocellular carcinomas originating in the caudate lobe underwent percutaneous ethanol injection as a curative treatment. The outcomes of percutaneous ethanol injection and the survival of the 7 patients were evaluated. RESULTS: Percutaneous ethanol injection was successfully carried out with no severe complications in all patients. During follow-up periods local recurrence was noticed in a patient, that was treated with percutaneous ethanol injection again. Four patients had recurrence in other parts of the liver, who were treated with percutaneous ethanol injection alone or percutaneous ethanol injection and transcatheter arterial embolization. Six patients were alive for 12-55 months after percutaneous ethanol injection and 1 patient died of hepatic failure 15 months after the procedure. CONCLUSIONS: Percutaneous ethanol injection was a safe and effective treatment, and it would be an alternative therapy for hepatocellular carcinoma originating in the caudate lobe.

Aged↗
PubMed2000

Injectable small intestinal submucosa: preliminary evaluation for use in endoscopic urological surgery.

PURPOSE: We evaluated the possible use of small intestinal submucosa in endoscopic urological surgery by assessing the smooth muscle regenerative capabilities and physical response of various forms of injectable small intestinal submucosa in the canine model. MATERIALS AND METHODS: In blinded fashion we injected small intestinal submucosa in 12 dogs submucosally under direct vision using a 20 gauge endoscopic needle. The 4 small intestinal submucosa formulations varied in harvesting method and sterilization technique. Animals were divided into groups of 3 and sacrificed 2 weeks, 6 weeks, 3 months and 6 months after surgery. Each injection site was analyzed grossly and histologically. Smooth muscle regeneration was identified by alpha-smooth muscle actin immunohistochemical staining. RESULTS: We identified 2 injectable small intestinal submucosa formulations that induced progressive smooth muscle regeneration at the site of submucosal injection compared with controls. De novo smooth muscle cells appeared in single cell aggregates as early as 6 weeks and in globular aggregates at 3 months. By 6 months early muscle bundle formation was noted. These 2 injectable small intestinal submucosa formulations also had the best submucosal volume preservation of about 25% of injected material during the study period. CONCLUSIONS: Injectable small intestinal submucosa promotes progressive submucosal smooth muscle regeneration in the canine bladder. The combined regenerative and bulking abilities of injectable small intestinal submucosa make this compound unique and novel. The clinical usefulness of injectable small intestinal submucosa for endoscopic correction of reflux and incontinence deserves further investigation.

Animals↗
PubMedDate not supplied

Injection rates for neuroangiography: results of a survey.

BACKGROUND AND PURPOSE: Injection rates have attracted scrutiny because of an incident of an aneurysm rupturing during arteriography. We sought to determine the current injection rates for neuroangiography in the setting of aneurysm evaluation. METHODS: An e-mail survey was distributed to 90 neuroradiology program directors within the United States and Canada. The injection rates and total volumes of contrast material injected for the common carotid, internal carotid, and vertebral arteries were provided for an "average" adult individual evaluated for intracranial aneurysms. RESULTS: Sixty-three (70.0%) program directors replied to the survey. Of these, five perform hand injections only and provided approximate values. The mean injection rates (SD) and total volumes (SD) for common carotid arteries were 7.2 cm(3)/s (1.8) and 9.9 cm(3) (2.0), respectively; for internal carotid arteries, 5.8 cm(3)/s (1.4) and 7.9 cm(3) (1.5); and for vertebral arteries, 5.4 cm(3)/s (1.2) and 7.8 cm(3) (1.7). The modes (rate/total) for the common carotid, internal carotid, and vertebral arteries were 7/12, 6/8, and 5/8, respectively. Forty-eight (81.4%) of 59 respondents did not believe a reduction in current injection rates would lead to a diminution in complications of arteriography. CONCLUSION: The rates of injection of contrast material in the United States for neuroradiologic studies show great variability. It does not seem that reducing arteriographic complications is an impetus to reduce injection rates. The values in this survey can provide "industry norms" for injections in the common carotid, internal carotid, and vertebral arteries if these rates are challenged.

Canada↗
PubMed2002

What nonresponse to intracavernous injection really indicates: a determination by quantitative analysis.

PURPOSE: In addition to its usefulness as a therapeutic modality, intracavernous injection may also be done in a diagnostic capacity. While a good response to an intracavernous injection test rules out venous leakage, a failed erectile response to the test in the office setting may not be completely representative of the patient erectile state. We determined by quantitative analysis the likely significance of failure to respond to intracavernous injection testing. MATERIALS AND METHODS: Patients evaluated with the standard erectile dysfunction assessment at our andrology clinic between 1996 and 1999 were included in analysis. All 122 patients who did not meet study exclusion criteria underwent a test dose of intracavernous injection with papaverine, phentolamine and prostaglandin E1. Regardless of the response or lack of response to the test the men then underwent nocturnal penile tumescence testing, penile blood flow study and re-dose pharmacocavernosography. Results of these adjunctive tests were compared to the outcome of a papaverine, phentolamine and prostaglandin E1 intracavernous injection test by quantitative analysis. RESULTS: A total of 87 patients failed to respond to the test dose. Average age of the nonresponders versus responders was 46.8 versus 33.8 years. The duration of erectile dysfunction in nonresponders versus responders was 31.0 versus 13.7 months. Poor intracavernous injection responders required an average of 1.9-fold greater induction flow and 6-fold greater maintenance flow than good responders. Receiver operator characteristics (ROC) curve analysis revealed that the best predictors of the intracavernous injection test response were erectile dysfunction duration (ROC 0.99), patient age (ROC 0.87), maintenance flow (ROC 0.86), pressure loss (ROC 0.83) and resistive index (ROC 0.82). The ROC area for peak systolic velocity was 0.69. CONCLUSIONS: Our results indicate that age and erectile dysfunction duration alone are the most important variables affecting the results of an intracavernous injection test. However, in patients older than 40 years with a greater than 2-year history of erectile dysfunction failure to respond to intracavernous injection testing is most closely associated with venous insufficiency, as evidenced by the high ROC values for variables indicative of venous insufficiency, namely maintenance flow, pressure loss and the resistive index. Therefore, nonresponse to an office intracavernous injection test in an older patient with erectile dysfunction of long duration is most likely due to venous leakage. If only 1 confirmatory test is possible, cavernosometry provides the most information.

Adrenergic alpha-Antagonists↗
PubMed2002

Developmental competence in vivo and in vitro of in vitro-matured equine oocytes fertilized by intracytoplasmic sperm injection with fresh or frozen-thawed spermatozoa.

This study was undertaken to evaluate the development of equine oocytes in vitro and in vivo after intracytoplasmic sperm injection (ICSI) with either fresh or frozen-thawed spermatozoa, without the use of additional activation treatments. Oocytes were collected from ovaries obtained from an abattoir and oocytes classified as having expanded cumulus cells were matured in M199 with 10% fetal bovine serum and 5 microU FSH ml(-1). After 24-26 h of in vitro maturation, oocytes with a first polar body were selected for manipulation. Fresh ejaculated stallion spermatozoa were used for the experiment after swim-up for 20 min in sperm-Tyrode's albumen lactate pyruvate. Frozen-thawed spermatozoa from the same stallion were treated in a similar way. Spermatozoa were immobilized and injected into the oocytes using a Piezo drill. Presumptive zygotes were cultured in G1.2 medium for 20 or 96 h after the injection was administered, or were transferred to the oviducts of recipient mares and recovered 96 h later. In addition, bovine oocytes with first polar bodies were injected with the two types of stallion spermatozoa and fixed 20 h after injection to examine pronuclear formation. Fertilization rate (pronucleus formation and cleavage) at 20 h after injection of spermatozoa was not significantly different between fresh and frozen-thawed sperm groups in either equine or bovine oocytes. Pronucleus formation after injection of spermatozoa into bovine oocytes was significantly higher than that for equine oocytes (P < 0.05). There were no significant differences in cleavage rate or average number of nuclei at 96 h between equine oocytes injected with fresh or frozen-thawed spermatozoa. However, embryos developed in vivo for 96 h had a significantly higher number of nuclei in both sperm treatments compared with those cultured in vitro. These results indicate that good activation rates may be obtained after injection of either fresh or frozen-thawed equine spermatozoa without additional activation treatment. Injection of frozen-thawed equine spermatozoa results in similar embryo development to that obtained with fresh equine spermatozoa. In vitro culture of equine zygotes in G1.2 medium results in a similar cleavage rate but reduced number of cells compared with in vivo culture within the oviduct. Bovine oocytes may be useful as models for assessing sperm function in horses.

Animals↗
PubMed2002

Intraocular distribution of 70-kDa dextran after subconjunctival injection in mice.

PURPOSE: To investigate the intraocular distribution kinetics of 70-kDa dextran after subconjunctival injection. METHODS: The right eye of 15 mice received a single subconjunctival injection of a 1.5-microL solution of 0.25% 70-kDa tetramethylrhodamine-dextran (TMR-D). The distribution of fluorescent labeling in eye sections was examined by fluorescence microscopy at 0.25, 1, 4, 24, or 72 hours after the injection. The brightness and homogeneity of fluorescence in the sclera, choroid, and retina were scored near the injection site, on the side of the globe opposite the injection site, and adjacent to the optic nerve head. Fluorescence intensity within the sclera and choroid adjacent to the optic nerve was assessed quantitatively by imaging densitometry. RESULTS: TMR-D readily diffused transsclerally and dispersed throughout a large portion of the sclera, uvea, and cornea. Shortly after the injection, homogenous fluorescence was observed in the sclera and choroid on the same meridian as that of the injection site. This fluorescence gradually decreased in intensity with distance from the injection site. At the opposite meridian, fluorescence in the choroid was more intense than in the adjacent sclera and could be traced up to the ciliary muscle. TMR-D was also observed in the retinal and optic nerve vessels. The intensity of scleral and choroidal fluorescence adjacent to the optic nerve reached a maxima at 1 hour, and then decreased slowly, with half-lives of approximately 16 and 100 hours, respectively. Visible fluorescence was maintained at least until 72 hours in the sclera, choroid, iris, and cornea. Specific fluorescent labeling was never found in the contralateral eyes. CONCLUSIONS: Macromolecular 70-kDa dextran can be readily delivered to the mouse retina and uveal tissues by subconjunctival injection through transscleral diffusion, local hematogenous spread, and possibly movement through the uveoscleral outflow pathway. Subconjunctival injection may be a useful approach for delivering macromolecules to the retina and uvea.

Animals↗
PubMed2002

Injection of chemotherapeutic microspheres and glioma. IV: Eradicating tumors in rats.

Polymer microspheres can be easily injected into the brain to provide a local and sustained delivery of chemotherapeutics to a tumor or surrounding tissue subject to high rates of tumor recurrence following surgery. Building on previous studies that established the clear advantage of local, peritumoral injections of sustained release microspheres, the following experiments utilized two different approaches for maximizing the survival benefit in glioma-bearing rats. In the first experiment, a previously grown cortical tumor was debulked and animals received either one or two treatments with carboplatin-loaded microspheres (either 200 or 800 microg total carboplatin per treatment). In each case, the microspheres were injected along the perimeter of the resection cavity with each treatment separated by 20 days. Survival studies clearly demonstrated that two, temporally spaced injections were superior to a single series of injections. At the lowest dose tested (200 microg), median survival was increased an additional 40% over that in animals receiving one treatment. At the higher dose (800 microg), one third of the animals receiving two separate treatments were long-term survivors (> 150 days) and showed complete eradication of the tumor on histological examination. In the second experiment, we directly compared the efficacy produced by sustained release carboplatin or 1,3-bis[2-chloroethyl]-1-nitrourea (BCNU) alone versus injecting carboplatin and BCNU-loaded microspheres blended together as a single suspension. Carboplatin and BCNU both enhanced survival, with BCNU being significantly less effective than carboplatin. However, the greatest improvements in survival were seen when a blended suspension of carboplatin and BCNU microspheres was injected around the surgical cavity. In contrast, spatially alternating injections of BCNU and carboplatin microspheres was significantly less effective and the increase in survival was no greater than that achieved with BCNU alone. These data offer further support for the potential utility of local, sustained release chemotherapeutic microspheres for treating glioma. Moreover, they suggest that injectable chemotherapeutic microspheres may offer important advantages by (a) permitting multiple, temporally spaced injections to be made, as needed, and (b) providing the opportunity to deliver combinations of several different efficacious drugs directly to the tumor site to enhance survival beyond what can be achieved with delivery of any single chemotherapeutic agent.

Animals↗
PubMed2003

[Survey of knowledge, attitude and behavior regarding safe injection among health practitioners in Shandong, China].

PURPOSE: To assess the knowledge, attitude and behavior of health practitioners (HPs) about safe injection in Shandong, China and to clarify risk factors related to unsafe injection and improper handling of used disposable syringes. METHODS: A cross-sectional study of 497 HPs in three-levels of health units (village clinic, township health center, and county hospital) in two areas of Shandong, China was carried out using a questionnaire. RESULTS: 468 HPs returned completed questionnaires. The proportion that did not receive formal medical education in the village (21.5%) was higher than in the township (9.9%) and in the county (2.5%). Proportions of HPs who only used disposable syringes were 97.0% in the county, 81.1% in the township and 69.0% in the village. Scores for safe injection knowledge among village HPs were significantly lower than those with township and county HPs (P < 0.001). Rate of unsafe injection practice was 6.2%, rate of improper handling of used disposable syringes was 7.6%, and both of which were significantly greater at the village level. Four factors were found to be significantly related to unsafe injection practice (P < 0.05): lower than middle level professional grade; knowledge scores of < 15 (full score 18); thinking that AIDS is not a terrible disease; and thinking that patients would accept the practice of sharing the same syringe for different persons. Four factors were found to be significantly related to improper handling of used disposable syringes (P < 0.05): working in the village; knowledge scores of < 15; thinking that patients would accept the practice of sharing the same syringe for different persons; and unwillingness to properly handle used disposable syringes. CONCLUSIONS: HPs working in village clinics had comparatively high rates of unsafe injection practice and improper handling of used disposable syringes, and a lower level of knowledge about safe injection. Lack of knowledge about safe injection was a risk factor for both unsafe injection and improper handling of used disposable syringe. Therefore, interventions should focus on this insufficient level of safe injection knowledge.

Adult↗
PubMed1952

Poliomyelitis and parenteral injections; a review of recent literature.

Data presented in the literature as to the relationship of poliomyelitis and recent prior injections include several aspects. the coincidence of paralysis in the same site as a recent injection has been considered the most definitive evidence. The fact of an inordinately large number of cases of paralysis of an arm where a recent previous antigen injection was recorded offered less specific corroboration. The larger number of cases among persons who had had an injection in the month preceding onset than among persons with injections in more distant months was noted. This observation was supported when similar information was obtained in a comparison of injection histories for persons who had the disease with the histories of persons who did not have it. The interval between injection and onset among persons who had the disease within a month of injection suggested something other than chance relationship. There is limited information indicating increased severity of paralysis in the injected limb. Evidence is divided on whether or not there is more paralytic disease among patients with recent injections. Similarly, the evidence is no more than suggestive with regard to increased severity of spinal paralytic disease. The mechanism or nature of such a phenomenon is unexplained. However, as Anderson and Skaar said, "considerable attention must be attached to the fact of uniformity of results in a series of independent observations even though each may be small."

Humans↗
PubMedDate not supplied

Determinants of therapeutic injection overuse among communities in Sindh, Pakistan.

BACKGROUND: Unsafe injections including reuse of disposable syringe is very common in developing countries including Pakistan. Healthcare providers unnecessarily prescribe injections to patients suggesting that patients ask for injections. We conducted this qualitative study to determine the reasons of overuse of therapeutic injections by the communities in Sindh province of Pakistan. METHODS: Using field-tested focus group guides of World Health Organization, eighteen focus group discussions (FGDs) were conducted with community members of rural Sindh, peri-urban and urban Karachi during January-February 2001. RESULTS: Injections are overused in Sindh, Pakistan, because patients prefer them, believing that they provide quick relief, and perceive them as a therapeutic norm and standard practice. According to community members initiative of prescription of injections are taken by doctors. Overuse of injections is of particular concern as patients are not aware of the risks associated with reuse of injection equipment. Doctors and television are considered as the most credible source of providing healthcare information. CONCLUSION: There is a need to educate communities regarding rationale use of therapeutic injections. Open discussion and frequent communication between doctors and patient should be encouraged. Mass media could play a vital role in educating communities about risks of unsafe injections.

Adolescent↗
PubMed2005

Use of superparamagnetic microbeads in tracking subretinal injections.

PURPOSE: The purpose of these studies was to develop a method to track intraocular injections. METHODS: Retinal pigment epithelial (RPE) cells, purified from adult mouse eyes, were incubated with superparamagnetic microbeads (Dynabeads, 4.5 microm) coated with bovine serum albumin to verify that they could phagocytose the microbeads. For in vivo tracking studies, mice were anesthetized and a small incision was made at the pars plana and 2 mul of microbeads (around 10(5) microbeads) or RPE that had taken up the microbeads were injected into the subretinal space (SRS). Mice were sacrificed at various times after injection. The eyes were enucleated, fixed in formalin, and embedded in paraffin. Sections were stained with H&E, visualized by light microscopy. Some eyes were digested with collagenase and inflammatory cells determined by flow cytometry. RESULTS: Cultured adult RPE phagocytosed the magnetic microbeads. One day after injection into the SRS, a retinal detachment was observed at the injection point and free microbeads were easily detected at this site. One week later, the host RPE cells had phagocytized the microbeads and the retina had reattached. No inflammatory response was detected in the eyes that were injected with microbeads in the SRS at any time examined. Histology showed normal morphology of all retinal layers around the injection site. The microbeads remained in situ throughout the study. CONCLUSIONS: Protein coated magnetic microbeads are non-inflammatory after injection into the SRS. Host RPE cells phagocytized the microbeads and the retina maintained a healthy morphology after reattachment. This technique proved not only to be a good training tool to determine the precise location of injection, but also provided a noninflammatory method for long term marking of delivery into the SRS. However, the microbeads can not be used as a tracer of injected RPE because the microbeads were readily transferred to the endogenous RPE.

Animals↗
PubMedDate not supplied

Our experience with epidural steroid injections in management of low backpain and sciatica.

BACKGROUND: Low back pain and sciatica is a common clinical condition. It is a most common orthopaedic complaint in the Kaski region of Nepal. The reason for its increased incidence may be hilly terrain, difficult working and living environment of the region. The initial treatment of Low back pain is conservative. Epidural steroid injection is being slowly established as are liable mode of conservative management in many orthopaedic centres of the world. This is a preliminary report of on-going study of the use of epidural steroid in the management of low back pain cases coming to the orthopaedic department of Manipal Teaching Hospital. METHODS: Prospective clinical trial was carried out on the patients reporting with low back pain and sciatica not responding to other modes of conservative treatment. Pre and post injection evaluation was done clinically. The level of pain, improvement in physical signs and ability to do activities of daily living were noted. RESULTS: Fifty two patients were observed for the average duration of 2.87 months. Average duration of symptoms was for 10 months. After first epidural steroid injection 83% of patients reported relief on day one. In some cases the onset of analgesia was delayed. Four patients reported no relief after first injection. Fifteen patients were given two injections and four received three injections. The average duration between two injections was three weeks. Average duration of pain relief was 20 days. At the end of 3 months, good results were seen in 39%, fair in 33% and bad results in 27%. Overall 59% of patients were able to do activities of daily living. Three patients (5.76%)required operation for disc prolapse. Postoperatively two patients reported back with back pain. Most common complaint of patients after injection was pain at the injection site. No major complications were encountered. CONCLUSION: Epidural Steroid Injection is a safe and effective mode of treatment of Low Back Pain. It provides painfree period to enable the patient for physiotherapy which helps in early recovery.

Adult↗
PubMed2006

[Experiences with botulinum toxin injections against spasticity in children].

BACKGROUND: Botulinum toxin injection is one of the newer options in the treatment of spasticity. Treatment with botulinum toxin is always combined with physiotherapy and often with casting. We show the extent to which botulinum toxin treatment has been taken into use in our department and discuss advantages and disadvantages of giving botulinum toxin injections at local hospitals. MATERIAL AND METHODS: 88 children with cerebral palsy aged 14 months to 16 years were treated with botulinum toxin between March 2000 and Dec. 2004. Injections were given in an outpatient setting, usually with the patient sedated with midazolam. Clinical examination after injection included assessment of spasticity and range of movement of joints. Motor function was videotaped. Side effects were continuously supervised. RESULTS: We performed 278 treatments; during the last year (2004) 7 treatments a month on average. 59 children were injected in lower limbs only, 14 were injected in upper limbs only, and 15 were injected in both upper and lower limbs. No serious side effects were recorded, neither from the botulinum toxin itself nor related to the injection procedure. INTERPRETATION: Assessment of indications for the use of botulinum toxin is now part of the medical follow up for children with spastic cerebral palsy. Treatment can safely be given at the paediatrics department in a local hospital. Injection in superficial muscles of the lower limbs is an easy task, while injection in small muscles and deep-seated muscles requires more special skills.

Adolescent↗
PubMed2005

The high-dose, alternate-week intravitreal ganciclovir injections for cytomegalovirus retinitis in acquired immune deficiency syndrome patients on highly active antiretroviral therapy.

OBJECTIVES: To evaluate the efficacy, and complications of the high-dose, alternate-week, intravitreal ganciclovir injection for cytomegaloviral retinitis (CMVR) in acquired immune deficiency syndrome (AIDS) patients on highly active antiretroviral therapy (HAART). DESIGN: Retrospective case series. PARTICIPANTS: AIDS patients with CMVR and on HAART MATERIAL AND METHOD: The high-dose, 4 mg/0.1 ml, ganciclovir was injected intravitreally to the enrolled patients on an alternate-week basis. The patients were monitored clinically until the retinitis was inactive, then the injections were withdrawn. The injections were re-initiated if relapse occurred. MAIN OUTCOME MEASURES: The number of eyes achieved inactive retinitis and corresponded to the number of injections, number of relapses and corresponded duration, visual acuity during the injection, and complications of the injection. RESULTS: Inactive lesions were found in 42/51 eyes (82.40%), the corresponding mean number of injections was 5.4 (1-18) per eye. There was no relapse and the corresponded duration of follow-up was 5.1 months (1-16). The final visual outcomes were improved or stable in 26 eyes (50.9%). These visual outcomes were statistically related to initial visual acuity (p = 0.022) but not statistically related to the number of injections (p = 0.929). Complications were found in 7/51 eyes (13.7%). They were vitreous haze, immune recovery uveitis, rhegmatogenous retinal detachment, and infectious endophthalmitis. CONCLUSION: The high-dose, alternate-week, intravitreal injection of ganciclovir may be an alternative for the treatment of CMVR in AIDS patients who are on HAART However, the induction course is longer than the weekly regimen and close monitoring of patients is essential.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Verification of palpation-guided intra-articular injections using glucocorticoid-air-saline mixture and ultrasound imaging (GAS-graphy).

OBJECTIVE: To examine a contrast medium method using a glucocorticoid-air-saline mixture and ultrasound imaging (GAS-graphy) for the verification of palpation-guided injections in different joints and to assess the inter-reader reliability of the method. METHODS: A palpation-guided injection of an air-steroid-saline mixture was given into a joint or tendon sheath of 133 consecutive patients. The dynamic ultrasound monitor images of the joints and tendons involved were videotaped before and after the injection. A rheumatologist and two radiologists analyzed separately the video clips of each patient, under blinded conditions. The readers evaluated the accuracy of the injections and the difficulty of the reading process. The inter-reader agreement was assessed by calculating the percentual values and overall kappa coefficient between the readers. RESULTS: The overall accuracy of the successful injections was 76%, 80% and 82 % evaluated by the three readers. In six out of the ten injection sites the accuracy was higher than 80%. The clarity of the method evaluated by the readers was 8, 8 and 8.5 on a scale from 0 to 10. The inter-reader agreement assessed by percentual values was 84.2%, 85.0% and 88.7%. The kappa coefficient between all readers was 0.595 showing moderate agreement. CONCLUSION: The GAS-graphy method for the verification of palpation-guided injections is a simple procedure performable to any joint site and the result can be seen immediately on the monitor after the injection. The reliability of the method is good and it can be used in developing injection techniques as well as in medical or nurse education. The method can be used as an alternative for the radiographic contrast medium method in verifying successful palpation-guided intra-articular injections.

Adult↗