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PubMed2006

Benefit of intraarticular corticosteroid injection under fluoroscopic guidance for subtalar arthritis in juvenile idiopathic arthritis.

OBJECTIVE: To determine the demographics of subtalar arthritis, the response to intraarticular corticosteroid injection, and the injection complication rate in a clinic sample of children with juvenile idiopathic arthritis (JIA). METHODS: A chart review was performed of all patients at a tertiary medical center who underwent subtalar corticosteroid injection during the past 5 years. Injection of 1 ml of triamcinolone hexacetonide or acetonide into the midsubtalar joint was performed using a lateral oblique approach under fluoroscopic guidance. Improvement was defined by enhanced foot inversion and eversion at the following office visit. RESULTS: Thirty-eight patients underwent 55 subtalar injections during the study period. All 7 JIA subtypes were represented. Thirty-one patients (82%) had subtalar arthritis at time of JIA diagnosis and 32 (84%) had concomitant tibiotalar ankle arthritis. Improvement was observed following 34 (89%) of the initial 38 injections. The mean duration of improvement was 1.2 years (SD +/- 0.9). Twenty patients (53%) developed hypopigmentation or subcutaneous atrophy. This complication was associated with a higher volume of injected corticosteroid per patient weight (p = 0.02) and with less efficacious injections (p = 0.04). CONCLUSION: Subtalar arthritis in children with JIA is common. Similar to other joints, subtalar arthritis responds to corticosteroid injection in approximately 90% of cases and often remains improved for greater than one year. Hypopigmentation and subcutaneous atrophy are frequent complications and are likely related to the dose of injected corticosteroid and possibly the accuracy of needle placement.

Adolescent↗
PubMed2006

Automated contrast injection in contemporary practice during cardiac catheterization and PCI: effects on contrast-induced nephropathy.

OBJECTIVES: To evaluate the incidence of contrast-induced nephropathy (CIN) with the use of an automated contrast injection system in conjunction with contemporary measures to prevent CIN after cardiac catheterization and percutaneous coronary intervention (PCI). BACKGROUND: The use of automated contrast injection systems can reduce the volume of procedural contrast, but whether lower contrast volume is associated with a lower incidence of CIN is uncertain. METHODS: The incidence of CIN was assessed in 1,798 patients after diagnostic catheterization or PCI at Wake Forest University Baptist Medical Center from April 2002 to November 2004 using traditional handheld manifold injection systems, and in 377 subsequent patients using an automated contrast injection system. Preprocedural hydration was used on a routine basis, and N-acetylcysteine and bicarbonate infusion were used on an ad hoc basis. Outcomes were adjusted by standard logistic regression modeling. RESULTS: Mean contrast volume (+/- standard deviation) per case was reduced from 204 +/- 147 ml to 146 +/- 108 ml, p < 0.05 by use of automated contrast injection. The incidence of CIN was 19.3% using manifold injection, and was 13.3%, p < 0.05, after use of automated contrast injection. The use of automated contrast injection was associated with a reduced relative risk of CIN, 0.66 (0.47-0.93), compared to manual injection, even after adjustment for baseline clinical and procedural covariates. CONCLUSIONS: The use of an automated contrast injection system in conjunction with contemporary hydration and pharmacologic strategies to prevent CIN during diagnostic catheterization and PCI was associated with a significant reduction in the use of contrast volume, as well as in the incidence of CIN.

Aged↗
PubMed1990

Rotation of the anatomic regions used for insulin injections and day-to-day variability of plasma glucose in type I diabetic subjects.

Treatment of type I diabetes mellitus is hindered by the often large fluctuations in blood glucose concentration experienced by affected individuals. To determine to what extent day-to-day variation in blood glucose levels can be reduced if insulin is injected in the same anatomic region rather than in different regions using a rotational scheme, as is commonly recommended, 12 type I diabetic subjects were studied. Insulin injections were given in the abdomen for 3 days and rotated among arms, abdomen, and thighs for 3 days using a crossover design with random assignment of treatment order. Blood samples for measurement of plasma glucose levels were obtained at nine scheduled times on each day. Insulin dose, diet, and physical activity were held constant for each subject. During the abdominal injection period, the mean SD of plasma glucose levels and the mean variance of plasma glucose levels were both less at all nine time points than during the rotating injection period. Overall values for the SD of plasma glucose levels were 2.7 +/- 0.2 mmol/L for the abdominal injection period and 3.7 +/- 0.3 mmol/L for the rotating injection period. Overall values for the variance of plasma glucose levels were 9.2 +/- 1.4 mmol2/L2 for the abdominal injection period and 17.4 +/- 2.2 mmol2/L2 for the rotating injection period. We conclude that the common clinical practice of rotating the anatomic regions used for insulin injections increases day-to-day variation in blood glucose concentration. Use of a single anatomic region, eg, the abdomen, for all insulin injections may reduce this variation and allow greater precision in the adjustment of insulin doses.

Abdomen↗
PubMedDate not supplied

The influence of temperature and speed of injection on the distribution of a solution containing bupivacaine and methylene blue in a spinal canal model.

Three milliliters of a solution containing 4.81 mg bupivacaine base and 0.029 mg methylene blue per milliliter (BMB) was injected in the middle of a vertically mounted spinal canal model containing 0.9% NaCl at 37 degrees C. The BMB solution injected was either equilibrated to 37 degrees C (Exp. I) or to 22 degrees C (Exp. II). Each experiment was conducted eight times, four times with a high speed of injection (+/- 0.6 ml/sec) and four times with a slow speed of injection (0.05 ml/sec). The density of the BMB solution was determined at 37 degrees C and at 22 degrees C and found to be, respectively, slightly hypobaric and slightly hyperbaric relative to the 0.9% NaCl solution of 37 degrees C. Three minutes after completion of the injection, nine 1-ml samples were drawn simultaneously from the site of injection and from eight sampling sites situated equally above and below the site of injection at 5-cm intervals, which were subsequently analyzed for methylene blue concentrations. Injection of the BMB solution equilibrated to 37 degrees C resulted in a distribution directed mainly upward, whereas injection of the BMB solution equilibrated to 22 degrees C showed distribution in a mainly downward direction. Variation in methylene blue concentrations was large, and no definite differences based on different speeds of injection were observed. It is concluded that small differences in baricity result in largely different distribution patterns that could explain the variability in sensory levels of blockade when using an isobaric solution for spinal anesthesia.

Bupivacaine↗
PubMedDate not supplied

Glomerular filtration rate estimated after multiple injections of contrast medium during angiography.

In twenty-six patients referred for angiography, clearance of contrast medium was determined with x-ray fluorescence analysis after multiple injections of contrast medium. A formula for correction of the injected amount, which takes into consideration the different times of contrast medium injections, approximating the total injected amount into one injection, was used. A single injection clearance of 51Cr-EDTA was determined at the same time. The results showed a good correlation between the clearance of contrast medium after multiple injections and the 51Cr-EDTA clearance after a single injection (r = 0.945). The correlation between contrast medium clearance calculated without correction for the different injection times, and 51Cr-EDTA clearance was the same (r = 0.946), due to short angiography time and rather low clearance values in our patients. It is concluded that total plasma clearance of contrast medium can easily be estimated after multiple injections. In this way patients with a risk of developing post-angiographic renal failure can be found.

Adult↗
PubMed1988

[Effects of endoscopic intratumoral injection of lentinan in patients with gastric cancer].

We studied the effects of endoscopic intratumoral injection of Lentinan in 7 patients with advanced gastric cancer. Ten to 14 days before surgery, Lentinan at a dose of 3 mg was endoscopically injected into the cancer tissues. The effects of Lentinan injection were evaluated by immunohistochemical staining for lymphocyte subsets in the resected specimens and by the natural killer (NK) activity of peripheral blood lymphocytes before and after injection. The distribution of lymphocyte subsets in cancer tissues was compared with those of 7 patients with advanced gastric cancer without Lentinan injection (control group). The ratios of CD 8+ cells and CD 25+ cells to CD 3+ cells in cancer tissues were statistically higher in the group given Lentinan injection than in the control group. The NK activity of peripheral blood lymphocytes significantly increased from 16.0 +/- 4.6% before injection to 21.1 +/- 5.1% after injection. However, there were no changes in lymphocyte subsets during this period. There were no side effects caused by the Lentinan injection. We conclude that endoscopic intratumoral injection of Lentinan may enhance local and systemic immunity in patients with gastric cancer.

Adult↗
PubMed1988

A field trial among leprosy patients in Nigeria with depot injections of dapsone and monoacetyldapsone.

In two field trials in Nigeria, 74 male and female leprosy outpatients received intra-adipose depot injections of either dapsone (DDS) or monoacetyldapsone (MADDS) at 4-week intervals. Blood samples were taken regularly and sent to Amsterdam to determine the DDS and MADDS concentrations in serum using high-pressure liquid chromatography (HPLC). The DDS injection yielded a good sustained drug release. After repeated administration accumulation occurred, demonstrated by a statistically significant increase in the area under the curve (AUC) in time: until 28 days after the first injection, the mean AUC (+/- S.D.) amounted to 19.3 +/- 5.6 mg d/l in males and 15.1 +/- 5.2 in females; after the fourth injection, 26.4 +/- 7.5 and 24.6 +/- 9.0 mg d/l, respectively (p less than 0.001). One male patient developed an abscess at the injection site; otherwise no side effects were observed. Even better sustained-release results were observed with the MADDS injection. Unfortunately, the injection caused a number of abscesses. Consequently, the DDS injection was very well received by the patients of the DDS study, while half of the patients in the MADDS study would prefer tablets to the MADDS injection. Further investigations are required to find the cause of the abscesses before one of the injections, or possibly a combination of both, could be implemented in the multi-drug treatment regimen proposed by WHO to provide a valuable tool to combat noncompliance among leprosy patients.

Abscess↗
PubMed1987

Muscle necrosis in Syrian hamsters resulting from intramuscular injections of ketamine and xylazine.

To assess tissue damage resulting from intramuscular injection of mixtures of ketamine and xylazine, 48 hamsters were given 100, 150 or 200 mg/kg ketamine and 10 mg/kg xylazine in one hind leg and an equal volume of sterile physiologic saline in the other leg. Four hamsters from each group were killed 1, 3, 7 and 14 days after injection and the tissues at the injection sites were examined. There was grossly apparent muscle necrosis in most of the ketamine-xylazine injected legs. By light microscopy, 47 of 48 legs injected with ketamine-xylazine had moderate to extensive muscle necrosis with an acute to chronic inflammatory response, depending on the time elapsed since injection. Microscopic slides of the injection sites were coded, randomized and scored for severity of muscle lesions. Lesion scores for ketamine-xylazine injected legs were significantly higher than controls at all post-injection times. These findings indicate that intramuscular injection of ketamine with xylazine can cause extensive muscle necrosis in hamsters and should not be used for anesthesia in survival procedures.

Animals↗
PubMed1981

[A new treatment of malignant brain tumor -1: local injection of bleomycin (author's transl)].

This is a paper of new trial of treatment of malignant brain tumor by local injection of bleomycin (BLM). The new method of intraneoplastic BLM injection is as follows: in the cases ended up with subtotal or partial removal of the tumor, Ommaya's device was detained in the tumor bed, and its reservoir was fixed subcutaneous on the skull. 0.1 mg/kg to 0.2 mg/kg of BLM was injected by subcutaneous puncture into the reservoir every other day. Usual total dose of BLM was 30-80 mg. The patients were usually treated with 60Co-irradiation and immunotherapy after local injection of BLM. Twelve patients with malignant brain tumor were treated by the above mentioned new method and a follow-up study was done. One-year survival rate was 50% and three-year survival rate was 25%. Each case of primary sarcoma, medulloblastoma and malignant oligodendroglioma survived for a very long time. However, most of the patients especially those with glioblastoma died of recurrence in about one year or so inspite of temporary improvement of their clinical symptoms and clinical findings. In the autopsy cases of malignant gliomas, similar pathological findings were obtained around the tumor bed. In macroscopical view, the extensive necrotic foci and small haemorrhages were observed around the tumor bed not deeper than 2 to 3 cm from the surface of the cavity, and in the deeper part the tumor tissues were actively proliferating. Microscopically there was a severe coagulation necrosis of tumor cells with haemorrhage, collagenous tissue proliferation, fibrin deposit, increasing capillary vessels and infiltrating lymphocytes and granulocytes. Consequently, the scintillation scanning of BLM labelled 57Co was utilized to make clearance curves of the drugs in the patients with malignant brain tumor. The results were as follows: 57Co-BLM activity in the tumor tissue decreased about 70% 2-4 days after local injection of the drugs, whereas, it decreased about 70% 2-4 hours after intravenous injection of the drugs. From these results it could be presumed that locally injected BLM remained in the tumor tissues for a longer time and killed malignant tumor cells completely. However, an unfavorable fact was that locally injected BLM was retained only within the tumor tissue less than 2-3 cm apart from the cavity, showing no efficacy enough to prevent tumor proliferation in more remote area. In conclusion, the local injection of BLM seems to be very effective for the treatment of malignant brain tumors if it is used together with intravenous or intraarterial injection of other chemotherapeutic drugs.

Adolescent↗
PubMedDate not supplied

Erythropoietin-mediated erythrocytosis in rodents after intrarenal injection of nickel subsulfide.

Rats and guinea pigs developed pronounced erythrocytosis at one to four months after unilateral intrarenal (ir) injection of nickel subsulfide (Ni3S2). For example, at two months after ir administration of Ni3S2 (5 mg) to rats, blood hematocrit values averaged 70 +/- 3 percent (p less than 0.001 vs. 48 4/- 2 in controls); at two months after ir administration of Ni3S2 (20 mg) to guniea pigs, blood hematocrit values averaged 67 +/- 6 percent (p less than 0.001 vs. 49 +/- 1 percent in controls). Hamsters and gerbils did not develop erythrocytosis after ir injection of Ni3S2 (5 mg/animal). Administration of Ni3S2 to rats by intrasplenic injection did not increase blood hematocrit; splenectomy did not prevent erythrocytosis in rats that received ir injection of Ni3S2. Erythrocytosis in rats was completely blocked by excision of the Ni3S2-injected kidney but was unaffected by excision of the non-injected kidney. Partial inhibition of Ni3S2-induced erythrocytosis in rats occurred after simultaneous ir injection of Mn, Cu, or Al dusts, benzo(a)pyrene, or subcutaneous (sc) infusion of sodium diethyldithiocarbamate. Erythrocytosis induced by ir injection of Ni3S2 was augmented by ir injection of Cr dust or intramuscular (im) administration of iron-dextran. Erythrocytosis occurred in rats after ir implantation of Ni3S2 within semi-permeable cellulose tubules, indicating that phagocytosis of Ni3S2 particles is unnecessary for erythropoietic stimulation. Erythropoietin (Ep) activity in rat serum increased sixfold at two weeks after ir injection of Ni3S2 (p less than 0.001 vs. controls), but Ep activity in pooled extracts of Ni3S2-treated rat kidneys did not increase significantly. This study identifies several factors that influence erythropoietic stimulation by Ni3S2, and furnishes salient information concerning the pathogenesis of Ni3S2-induced erythrocytosis.

Animals↗
PubMed1980

Myotoxicity of single and repeated injections of mepivacaine (Carbocaine) in the rat.

Young rats received single or repeated injections of 2% mepivacaine (Carbocaine) into the tibialis anterior or extensor digitorum longus muscles. Repeated injections consisted of six injections of the anesthetic (100 microliter per injection into the tibialis anterior) on three different schedules, at intervals of 2 1/2 hours, 24 hours, or 4 days. The muscles that had been given injections were examined histologically for evidence of myotoxicity at 0 to 7 and 20 days after the last injection. Single injection studies showed that mepivacaine is a myotoxic drug, producing a lesion which ultimately results in the degeneration and subsequent regeneration of large amounts of muscle. A similar picture was seen with repeated injections except that greater tissue destruction was noted. Long-term studies following a single injection of mepivacaine showed restoration of the original muscle structure whereas after repeated injections some muscles showed persisting foci of increased intersitial connective tissue. This study shows that in rats 2% mepivacaine is a myotoxic drug, but that the damage it produces is to a large extent restored by the regeneration of new muscle fibers.

Animals↗
PubMed1995

[Epidural injection for postoperative pain relief after thoracoscopic surgery].

For the pain relief after thoracoscopic surgery, the epidural injection of buprenorphine was performed in 46 cases. In 28 cases, intermittent injection was performed before awaking from anesthesia. The effect was excellent in 6 cases, who were free from pain without any more injection after returning to the ward, and good in 27 cases, who sometimes felt dull pain and had another analgetics (intermittent epidural injection in 16 cases, intermittent epidural injection and another medication in 5 cases). In 18 cases, continuous injection was performed. The effect was excellent in 9 cases and good in 9 cases. It was concluded that the epidural injection had effective analgesic effect after thoracoscopic surgery, both in intermittent injection group and continuous injection group. For limited medication, the intermittent epidural injection was considered the first choice after thoracoscopic surgery.

Analgesia, Epidural↗
PubMed1993

Intraocular dexamethasone penetration via subconjunctival or retrobulbar injections in rabbits.

Using high-performance liquid chromatography, we compared tissue levels of dexamethasone in the aqueous, vitreous, retina, and choroid of rabbits, 1 and 4 hours following subconjunctival or retrobulbar injection. One hour following injection, dexamethasone levels in all of these tissues were similar in both the subconjunctival and retrobulbar groups. Four hours following injection, the concentrations in the two groups also were similar, except in the choroid, in which the subconjunctival injection yielded significantly lower dexamethasone levels than the retrobulbar injection. Tissue steroid levels were comparable ipsilateral and contralateral to the injected eyes in both treatment groups after 4 hours, except in the retina, in which the levels were lower in the contralateral eye after subconjunctival injection. These data suggest that dexamethasone absorption and delivery is predominantly hematogenous following both subconjunctival and retrobulbar injection, especially in highly vascular tissues, such as the choroid. Hematogenous delivery of dexamethasone appears to peak earlier in the choroid and presumably in other intraocular tissues following subconjunctival injections, while retrobulbar injections provide more steady, long-term delivery.

Absorption↗
PubMed1993

Unilateral versus bilateral botulinum toxin injections in spasmodic dysphonia: acoustic and perceptual results.

The present study compared the effects of unilateral and bilateral thyroarytenoid injections of botulinum toxin (botox) for the treatment of adductor spasmodic dysphonia. Using electromyographic guidance, 15 patients received unilateral botox injections of 15 units each and 11 patients received bilateral injections of 2.5 units in each site. Acoustic recordings of the patient's voice were made prior to injection and at two- and six-week intervals after injection. Both the unilateral and bilateral botox injections were associated with significant improvements in spasmodic dysphonia. This was determined by the acoustic measures of vocal shimmer and the number of voice breaks per second and by the perceptual measures of voice spasm severity. Both types of injections were also associated with a significant increase in vocal breathiness at two weeks post-injection. In addition, a number of acoustic measures including maximum phonation time, vocal jitter, and the number of voice breaks/second indicated that unilateral botox injections may provide both superior and longer lasting benefits than bilateral botox injections.

Botulinum Toxins↗
PubMed1996

Forceful epidural injections for the treatment of lumbosciatic pain with post-operative lumbar spinal fibrosis.

OBJECTIVE: To evaluate the efficacy of forceful epidural corticosteroid injections in lumbosciatic pain ascribed to post-operative lumbar spinal fibrosis. METHOD: Randomized controlled study comparing forceful injections via the sacral hiatus of 125 mg prednisolone acetate + 40 ml saline (treatment group) and injections via the same route of 125 mg prednisolone acetate alone (control group). Results were compared after six and 18 months. The main evaluation criterion was a subjective assessment of overall efficacy done by the patient using a seven-level scale. RESULTS: After six months, the proportion of patients who were relieved of their sciatica was significantly higher in the forceful injection group (n = 29; 45%) than in the control group (n = 31; 19%) (p = 0.03). Success rates for low back pain were 29% and 6% in the forceful injection and control groups, respectively. Among secondary efficacy criteria, nerve root pain evaluated on a visual analog scale and by Schöber's index showed significantly greater improvement in the forceful injection group than in the control group. After 18 months, results were still in favor of the forceful injection group, with success rates of 39% for the sciatica and 31% for the low back pain. The proportion of patients who returned to work was similar in the two groups. CONCLUSION: Although mediocre overall, the results of forceful epidural corticosteroid injections are better than those of simple epidural injections of a corticosteroid alone. Given the paucity of effective treatments for lumbosciatic pain apparently due to postoperative fibrosis, forceful injections should be given a place in the treatment of this condition.

Adult↗
PubMedDate not supplied

Complications associated with epidural steroid injections.

BACKGROUND AND OBJECTIVES: Warnings about the hazards of epidural steroid injections occasionally appear in both medical and lay literature despite a lack of objective data to support such concerns. This literature review was undertaken to survey reports of adverse reactions associated with that procedure. METHODS: The following types of publications from peer-reviewed medical literature was surveyed: reports on series of epidural and subarachnoid steroid injections for sciatica; reports of adverse effects of epidural and subarachnoid steroid injections for sciatica; review articles on epidural and subarachnoid steroid injections; and studies of the behavioral and histologic effects of epidural steroids and their vehicle in animals. RESULTS: Several cases of aseptic meningitis, arachnoiditis, and bacterial meningitis and one case of conus medullaris syndrome have been reported after subarachnoid steroid injections. Most of these complications occurred after multiple subarachnoid injections. Two cases of epidural abscess, one case of bacterial meningitis, and one case of aseptic meningitis have been reported following epidural steroid injections. Subarachnoid drug placement could not be ruled out in the meningitis cases. CONCLUSIONS: There are few published reports of serious complications following epidural steroid injections. There are a few published reports of complications following subarachnoid steroid injections, most of which were associated with multiple injections over a prolonged time period.

Animals↗
PubMed1997

[Effect of injection speed on sensory blockade in spinal anesthesia with 0.5% hyperbaric tetracaine].

We investigation the effect of injection speed on sensory blockade in spinal anesthesia. Forty two female patients, scheduled for total abdominal hysterectomy, were allocated randomly to 3 groups of 14 each according to the injection speed of 0.5% hyperbaric tetracaine: Group F (fast; injection speed > or = 0.2 ml.s-1), Group M (moderate; 0.1 < injection speed < 0.2 ml.s-1) and Group S (slow; injection speed < or = 0.1 ml.s-1). Spinal puncture was performed via the median approach at the L3-4 interspace with the patient in a lateral position. The maximum level of sensory blockade was assessed by means of the pin-prick method in the midline 3, 5, 10, 20, 30, 60 minutes after injection. In Group F, the level of sensory blockade became higher quickly (within 5 min), but anesthetic effects were not so satisfactory. And, in this group, there were more patients with dyspnea than in other groups. We speculate that the turbulence made by fast injection in subarachnoid space caused unsatisfactory effects. In Group S, anesthetic level was becoming higher also 20 or 30 min after injection. The fixation of anesthetics requires about 30 min. In our opinion, anesthetics injected slowly were diluted less by CSF, and the actual baricity of them was higher, and this made the difference within 30 min. In Group M, anesthetic effects and patient's condition were stable. We suppose that this injection speed (0.1-0.2 ml.s-1) is suitable for spinal anesthesia.

Adult↗
PubMed1998

Substantially attenuated hemodynamic responses to Escherichia coli-derived vascular endothelial growth factor given by intravenous infusion compared with bolus injection.

Vascular endothelial growth factor (VEGF) produces beneficial angiogenesis in animal models of coronary and peripheral ischemia. However, intravenous bolus injection of Chinese hamster ovary cell (CHO)-derived VEGF produces adverse effects on hemodynamics. The present study examined pharmacokinetic and hemodynamic responses to Escherichia coli-derived VEGF, which will be used in clinical patients, compared with responses to CHO-derived VEGF, and tested whether intravenous infusion of E. coli-derived VEGF attenuates the hemodynamic responses compared with the responses observed with intravenous bolus injection. Hemodynamic parameters were measured before and after administration of VEGF in conscious, instrumented rats. Intravenous injection of both CHO- and E. coli-derived VEGF produced a similar maximal reduction in arterial pressure, although E. coli-derived VEGF exhibited less of a depressor effect in the initial phase after injection. Either infusion or injection of E. coli-derived VEGF caused hypotension, tachycardia and reduced cardiac output and stroke volume, which were significantly attenuated when given by infusion compared with injection. The maximal hypotensive and tachycardiac responses to infusion were decreased by 50 to 60% compared with those responses observed after injection. Cardiac output was maximally reduced by 34% after injection, but only 18% after infusion. A sustained elevation in systemic vascular resistance observed after injection was avoided after infusion. Thus, the hemodynamic side effects of VEGF administration can be substantially attenuated by controlling the rate of VEGF infusion. The data indicate that infusion, instead of bolus injection, is a more appropriate regimen for VEGF administration.

Animals↗