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PubMed2006

Effects of darbepoetin injections on erythrocyte membrane transport protein expressions in humans.

The present study investigated the effects of injected darbepoetin [novel erythropoietin stimulating protein (NESP)] on the density of three erythrocyte membrane transport proteins: the lactate-H+ cotransporter (monocarboxylate transporter 1), the chloride/bicarbonate exchanger 1 (anion exchanger 1), and the water channel aquaporin 1. Thirteen subjects were injected with NESP once a week for 4 wk. Blood samples were obtained before, during, and after the injection period, and the erythrocyte transport proteins were determined by Western blotting. The NESP injections induced a transient increase in hematocrit, red cell volume, and reticulocyte fraction. The density of aquaporin 1 protein was higher (maximal increase +59%) (P < 0.01) during the injection period compared with the preinjection value and lower (P < 0.01) after the injection period. The density of anion exchanger 1 protein was higher (maximal increase +15%) (P < 0.05) during the injection period compared with the preinjection value and tended (P = 0.06) to be lower after the injection period than before the injection period. The density of the erythrocyte monocarboxylate transporter 1 protein was higher (maximal increase +43%) (P < 0.05) during the injection period than in the preinjection period. Age separation experiments using self-creating Percoll gradients demonstrated a higher density of membrane transport proteins in young red blood cells. These data suggest that the NESP-induced increase in membrane transport proteins is caused by a higher fraction of newly formed erythrocytes (and reticulocytes), which have a higher density of membrane transport proteins. However, increased incorporation of membrane proteins during erythrocyte formation may also be involved. We suggest that NESP improves the quality of erythrocyte membrane transport through these mechanisms.

Adult↗
PubMed2002

Effect of substance P injection into the nucleus tractus solitarius of rats on cricothyroid and thyroarytenoid motor activity and cardiovascular and respiratory systems.

Identification of central neurotransmitters that mediate laryngeal adductor and/or tensor activity may prove useful in managing pathological laryngeal adduction as occurs in laryngospasm or apparent life-threatening events. The putative transmitter substance P (SP) is found in the nucleus tractus solitarius (NTS), in which laryngeal afferents terminate. Therefore, we studied the laryngeal, cardiovascular, and respiratory effects of SP injected into the NTS of rats. We completed bilateral stereotactic injections of 20 nL of SP (15 micromol) or control solution into the region of the NTS, the dorsal motor nucleus (DMN), or the nucleus gracilis (GR) in 30 anesthetized rats. Changes in diaphragm, cricothyroid (CT), and thyroarytenoid (TA) electromyography (EMG), as well as blood pressure (BP), were compared. The injection sites were verified histologically. Injection of SP into the NTS altered CT and/or TA EMG activity in all animals. The change ranged from complete inhibition, to a phasic increase, to a tonic increase. No change in laryngeal adductor EMG activity was seen in 8 of 9 animals after SP injections into the DMN (4/5) or GR (4/4), but 1 animal demonstrated brief inhibition of CT and TA EMG activity after SP injection into the DMN. Injection of SP into the NTS induced central apnea and a significant decrease in BP in all animals. The duration of apnea tended to be longer after NTS injections than after DMN or GR injections (p < .10 and p < .05, respectively). We conclude that stereotactic injections of putative neurotransmitters in rats may be accomplished to identify effects on laryngeal motor activity. Direct application of SP into the NTS consistently elicits a change in CT and/or TA EMG activity, ranging from inhibition to excitation. This model may prove useful in evaluating pharmacological targets of central reflex activity to manage life-threatening laryngeal reflex activity.

Analysis of Variance↗
PubMed1988

Injection of low-dose antigen attenuates the response to subsequent bronchoprovocative challenge.

Injection of low-dose antigen on a co-seasonal basis has been proposed as an alternative to conventional immunotherapy in allergic disorders. Few studies of efficacy have been attempted, and available data do not support the use of this technique. We evaluated the effect of low-dose antigen injection in 21 subjects with histories of asthma, after exposure to animal antigen. Each subject was injected with low-dose animal antigen, as determined by skin test end point titration, or with placebo. Twenty minutes after the injection, bronchoprovocative challenge was performed with the use of the same antigen. The provocative dose 20% (PD20), FEV1 after antigen injection, was 28.52 +/- 1.74, was compared to 6.50 +/- 1.15 after placebo injection (p less than 0.01). This experiment was repeated after pretreatment of patients with indomethacin. The protective effect of antigen injection was abolished. In a third experiment, the PD20, FEV1 for methacholine, was 10.74 breath units (BU) after antigen injection and 6.84 BU after placebo injection (PD less than 0.05). Low-dose antigen injection causes rapid reduction of bronchial sensitivity to inhaled antigen and methacholine. This effect is abolished by treatment with indomethacin.

Adult↗
PubMedDate not supplied

Ultrasound-guided thrombin injection is a safe and durable treatment for femoral pseudoaneurysms.

Ultrasound-guided percutaneous thrombin injection has recently been described as a treatment for postcatheterization femoral pseudoaneurysms. Although ultrasound guided compression offers another nonoperative treatment option, thrombin injection has shown superior initial success rates. Reports of follow-up for thrombin injection longer than 30 days are currently lacking. The authors reviewed their initial experience with thrombin injection and prospectively evaluated patients for occult late recurrences of pseudoaneurysm and for distal circulatory complications. Records and vascular laboratory data for all patients treated with ultrasound-guided thrombin injection were reviewed for an 18-month period. Tibial vessel Doppler waveforms and ankle/brachial indices were routinely obtained before and after thrombin injection. Follow-up duplex examinations were performed within 24 hours of initial treatment. In the prospective portion of the study, successfully treated patients underwent a repeat femoral duplex scan and lower extremity arterial examination for comparison with the pretreatment studies. Forty-nine of 52 femoral pseudoaneurysms (94%) were successfully treated with ultrasound guided thrombin injection. One immediate failure and 2 early recurrences were treated surgically. There was 1 thrombotic complication of the native circulation identified at the time of injection. Follow-up studies were obtained in 32 of 46 available patients with a mean length of follow-up of 9 months (range 3-17 months). No late recurrences of the pseudoaneurysms or arterial-venous fistulas were observed. No distal circulatory complications were detected by arterial waveform analysis. Three deaths occurred in the interim (cardiac related). Two patients were lost to follow-up. The remaining 12 patients reported no additional limb complications but declined to be restudied. Ultrasound-guided thrombin injection is a safe, effective, and durable treatment for iatrogenic pseudoaneurysms. Thrombin injection should be the therapy of choice for catheter-related femoral false aneurysms.

Adult↗
PubMed1978

Induction of cleavage in nucleated and enucleated frog eggs by injection of isolated sea-urchin mitotic apparatus.

Mitotic apparatus (MA) were isolated in glycerol-dimethylsulphoxide solution (MTME) from zygotes of sea urchins (Stronglyocentrotus purpuratus). Freshly isolated MA were stored in 1/10 strength MTME for varying periods of time and were then injected into unfertilized frog (Rana pipiens) eggs. These injections induced 40-60% of the recipient frog eggs to initiate cleavage, resulting in the formation of blastula cell clusters. The cleavage-inducing activity of MA stored in 1/10 MTME at room temperature decreased with time of storage in 1/10 strength MTME, and disappeared by about 6 h. There was no change in the ultrastructure of MA during storage. MA isolated and stored in MTME at room temperature had a constant level of cleavage-inducing activity during the first 48 h of storage, but this activity slowly declined upon further storage; almost no activity was left after 3 weeks. MA isolated in hexylene glycol (HG) and immediately transferred into MTME were compared with MA isolated in MTME; both MA had the same cleavage-inducing activity on the day of isolation, after which the MA isolated in HG quickly lost activity. On the other hand, MA isolated and stored in HG had little cleavage-inducing activity when tested 3 h following isolation. Cleavage-inducing agent (CIA) isolated from frog brains induced cleavage and blastula formation when injected into nucleated frog eggs, but had no such activity when injected into enucleated frog eggs. MA isolated in MTME induced cleavage and blastula formation in enucleated frog eggs as well as in nucleated frog eggs. Cytological examination revealed that blastula cells which developed from MA-injected enucleated eggs contained Feulgennegative nuclei, whereas cells which developed from CIA-injected nucleated eggs contained Feulgen-positive nuclei. These results suggest that sea-urchin nuclear materials participate in mitosis in frog eggs. Isolated MA which had been stored in MTME for 3 weeks and which exhibited little cleavage-inducing activity were injected together with frog brain CIA into either normal or enucleated eggs; normal recipient eggs cleaved with significantly higher frequencies (70%) than those injected with CIA alone (40%). Furthermore, enucleated eggs injected with CIA alone failed to cleave, while those injected with MA and CIA together cleaved with significant frequencies (overall 29%). This result suggests a cooperative interaction between CIA and the inactivated MA to restore the cleavage-inducing activity of MA.

Animals↗
PubMed1999

Drug absorption behavior after periocular injections.

The purpose of this study was to investigate the absorption behavior of an ophthalmic drug injected in rabbit periocular tissues. After intracapsular, retrobulbar and palpebral conjunctival injections of 150 microl and 50 microl fluorescein isothiocyanate dextran (FITC-dextran, average molecular weight 11000), leakage of the dye into the tear fluid was dependent on the injection route and volume. After periocular injections (50 microl) of tilisolol, as a model beta-blocker, the concentrations in the tear fluid, blood, aqueous humor and vitreous body were determined by HPLC. Slight drug leakage was observed in the tear fluid after injections. The periocular injections showed a faster absorption and a higher area under the concentration-time curve (AUC) in the plasma and a lower AUC in the aqueous humor than those observed in instillation. They also showed a higher ratio of AUC of tilisolol in the vitreous body to AUC in the aqueous humor than that observed in the instillation. Among the periocular injections, retrobulbar injection showed the highest concentrations in the plasma and the lowest in the aqueous humor and vitreous body, while intracapsular injection showed the lowest in the plasma and the highest in the aqueous humor and vitreous body. Although the periocular injections showed a rapid systemic absorption of drug by a rich topical vasculature, it might be an effective approach to deliver the drug to the periocular tissues and vitreous body.

Absorption↗
PubMedDate not supplied

Comparison of two formaldehyde administration methods of in ovo-injected eggs.

Formaldehyde administration in the hatchery can be very useful in decreasing microbial numbers. However, its use is controversial because of the adverse effects that can occur to chicks and people. This study was designed to look at alternative methods of application of formaldehyde in the hatchery. In addition, the study compared the effects of these methods of application on in ovo-and non-in ovo-injected eggs. All in ovo-injected eggs were given diluent only with no vaccine or antibiotic added. In hatchers containing both in ovo-injected eggs and non-in ovo-injected eggs, formaldehyde was administered two ways, dose (DOSE) and constant rate infusion (CRI). In the DOSE hatcher, 12 ml of formaldehyde was administered at one time every 12 hr, whereas in the CRI hatcher, the same volume was administered at a rate of 1 ml/hr over a 12-hr period. A control (CONT) hatcher received 12 ml of distilled water at the same time that the DOSE hatcher was given formaldehyde. In the DOSE hatcher, a peak concentration of formaldehyde of 102 ppm was reached. The CRI was maintained at approximately 20 ppm of formaldehyde. At pipping, the aerosol bacterial load in the hatchers receiving formaldehyde (DOSE, 130 colony-forming units [CFU]/m3; CRI, 82.5 CFU/m3) was significantly less than in the CONT hatcher (235 CFU/m3). At hatch, the CRI (337.5 CFU/m3) was not able to control bacterial levels and only the DOSE hatcher (150 CFU/m3) had a significantly lower aerosol bacterial count. The CRI non-in ovo-injected eggs (93.39%) had a significantly higher percentage of hatch of fertile compared with non-in ovo-injected eggs exposed to water (84.27%). In ovo-injected eggs in CONT and DOSE treatment groups contained significantly higher percentages of visual contamination than non-in on-injected eggs in the same hatchers. This difference had numerical significance only in the treatment groups within the CRI hatcher. The chicks were then placed into replicate treatment groups and grown for 14 days. Chicks from the CRI in ovo-injected eggs had a statistically significant improvement in feed conversion ratio (1.24) at 14 days when compared with chicks from CONT non-in ovo-injected eggs (1.29). All formaldehyde-exposed chicks had numerically lower feed conversion ratios compared with the CONT exposed chicks.

Animals↗
PubMed1975

Effects of injections of monoamine oxidase inhibitor or saline into the uterus in late pregnancy on uterine catecholamine levels related to abnormal parturition in rats.

Injection of a monoamine oxidase (MAO) inhibitor (nialamide) into the uterus of an anaesthetized and laparotomized rat on day 20 of pregnancy severely disturbed parturition. Injection of the solvent (0-9% isotonic NaCl solution) at the same stage of gestation produced the same but less frequent disturbances. When the rats were injected on days 19 or 21, impairment was less marked than on day 20. Therefore, day 20 seems to be a critical period for the onset of parturition. Injection of Ringer solution into the uterus on day 20 had effects analogous to those of saline injection at the same stage. Anaesthesia induced with ether, laparotomy of the pregnant rat on day 20, and handling of the uterine horns without injection of either Ringer or NaCl also disturbed parturition in 70% of the rats treated. Nevertheless, disorders were not as severe as those after injection. Laparotomy alone on day 20 did not disturb parturition. The effects on parturition of a saline injection into the uterus on day 20 were greatly decreased when the injection was performed on pregnant rats adrenalectomized on day 14, or on pregnant rats pretreated on days 18 and 19 with an agent blocking the adrenergic beta receptors (propranolol); 70-80% of the treated rats had normal deliveries. In control rats, uterine catecholamine levels were markedly modified between days 21 and 22 of gestation. These changes did not occur in rats injected with MAO inhibitor or saline.

Adrenalectomy↗
PubMed1987

Effects of injecting growth hormone or thyroxine on milk production and blood plasma concentrations of insulin-like growth factors I and II in dairy cows.

Three cows received injections of thyroxine (T4; 20 mg/day), four cows GH (40 mg/day) and three cows saline (control; 10 ml/day) on days 5-8 of a 16-day experimental period during peak lactation. Milk yield increased 13% in cows given GH (from 14.6 to 16.5 kg/day) and 15% in cows given T4 (from 15.8 to 18.2 kg/day) but did not change in control cows. Injection of T4 increased milkfat and lactose content but reduced milk protein content. Injection of GH was without effect on milk composition during the injection period but milk protein rose after injections ceased. Injection of T4 increased plasma concentrations of T4 and tri-iodothyronine six- to sevenfold, with maxima occurring on day 9. Injection of GH increased the plasma concentration of GH five- to tenfold 5 h after injection. The plasma concentration of insulin-like growth factor I (IGF-I) was increased in cows given GH in both morning (08.30 h) and afternoon (14.30 h) blood samples, the difference being greatest in afternoon samples in which plasma IGF-I content increased from 3.3 to 6.8 nmol/l. Injection of T4 reduced the plasma concentration of IGF-I in morning samples but the concentration in afternoon samples remained relatively constant throughout the 16-day experimental period. The plasma concentration of IGF-II rose in morning samples in all treatment groups to reach a maximum of 200-250 nmol/l by day 9. The galactopoietic response to injection of GH but not T4 was associated with an increase in plasma concentration of IGF-I. Changes in plasma concentration of IGF-II were not associated with changes in milk yield.

Animals↗
PubMed1993

Improvement of diabetic control and acceptability of a three-injection insulin regimen in diabetic adolescents. A multicenter controlled study.

OBJECTIVE: To compare the effectiveness and acceptability of a three-injection insulin regimen with the conventional two-injection therapy in an unselected population of diabetic adolescents. RESEARCH DESIGN AND METHODS: Some 205 patients aged 10-18 yr with IDDM, who were previously treated with two daily insulin injections, were included without any selection into a randomized trial. They were either switched to three (regular prebreakfast, regular prelunch, and [regular+ultralente] predinner) or remained on two ([regular+intermediary] prebreakfast and predinner) subcutaneous injections. They were evaluated after 1 yr of treatment. The major criteria of outcome of efficacy were the concentration of GHb, the frequency of severe hypoglycemia and DKA, and body weight. RESULTS: Of the patients, 82% accepted the three-injection regimen, and 83% accepted the two-injection regimen. At entry into the trial, no significant differences appeared between the two treatment groups nor among patients refusing the allocated regimen. Significant explanatory variables predicting initial diabetes control were duration of disease and adherence to diet. GHb, decreased from 9.8 +/- 0.1 to 9.3 +/- 0.2% (P < 0.05) in the three-injection group, whereas it increased from 9.5 +/- 0.3 to 9.8 +/- 0.3% (P < 0.05) in the two-injection group, resulting in a modest (0.75%) but significant difference (P < 0.05) between GHb change in the two groups. The difference reached 1.4% (P < 0.0002) in patients with GHb > 11.2% at entry. The frequency of hypoglycemia and DKA was similar in the two groups. None of the parameters known to potentially influence glycemic control changed during the trial, and, therefore, the improvement of GHb could be attributed to the pattern of daily insulin distribution per se. CONCLUSIONS: In the general diabetic adolescent population, the efficacy of a three-injection regimen is somewhat superior to that of a conventional two-injection regimen, particularly in patients previously poorly controlled. The acceptability of this regimen being excellent, its increased use should be considered in this age-group.

Adolescent↗
PubMed1982

Induction of lactation: comparison of injections of estradiol-17 beta and progesterone for 7 or 21 days on prolactin response to thyrotropin releasing hormone and milk yield in dairy cattle.

Subcutaneous injections of estradiol-17 beta and progesterone (.10 and .25 mg/kg of body weight) for 7 (group I) or 21 (II) days were used. Dexamethasone (.028 mg/kg of body weight per day) or adrenocorticotropin (200 IU per day) was injected into cows in each group on days 18 to 20 (I) or 32 to 34 (II). Additionally, 100 mug of thyrotropin releasing hormone was injected intravenously on days 1, 7, 17 (I) or 1, 7, and 31 (II). Milking was initiated on days 21 (I) or 35 (II). Overall 13 of 14 cows had mean daily yields of milk greater than 5 kg; 12 had 305-day lactations. Yields of milk in cows injected for 21 days were greater on day 1 and increased more rapidly until peak was reached at 10 wk; daily mean production throughout lactation was greater (14.3 versus 10.1 kg) than for cows injected for 7 days. Lactation curves pooled within cow within treatment differed. Concentrations of estradiol, estrone and progesterone increased during steroid injections and were 2- to 3-fold higher on day 21 in II than on day 7 (I or II), but concentrations of prolactin and total glucocorticoids in plasma did not differ during this time. The quantity of prolactin released in response to injection of thyrotropin releasing hormone was greater 10 days after steroid injections than before or during steroid injections. Preinjection concentrations of prolactin were correlated with magnitude of postinjection response to thyrotropin releasing hormone, but response was not correlated with concentrations of steroids in plasma on day of injection.

Adrenocorticotropic Hormone↗
PubMed2000

Corticosteroid injections in polymyalgia rheumatica: a double-blind, prospective, randomized, placebo controlled study.

OBJECTIVE: To determine the efficacy and safety of shoulder corticosteroid injections in polymyalgia rheumatica (PMR). METHODS: Twenty consecutive patients with active PMR were randomized into a 7 month, double blind, placebo controlled study. Patients received either bilateral shoulder injections of 40 mg of 6-methylprednisolone acetate or placebo (1 ml saline solution). Responders were treated weekly with the same regimen for a total of 4 bilateral injections and then followed for 6 months. Response was defined as a 70% reduction in visual analog scale (VAS) score for pain and for patient and physician global assessment, and duration of morning stiffness. Bilateral shoulder magnetic resonance imaging (MRI) was performed at different times to evaluate the response of lesions to therapy. RESULTS: All 10 corticosteroid treated patients responded to the first injection with a significant reduction in duration of morning stiffness, VAS pain scale, patient and physician global assessment, erythrocyte sedimentation rate, and C-reactive protein. Interleukin 6 serum levels were significantly reduced after the 2nd injection. In 5 patients, the response persisted throughout the followup period. The other 5 withdrew within 4 weeks after the 4th injection due to recurrence of symptoms. None of the 10 patients of the placebo group responded to the first injection. The difference between the 2 groups was significant (p = 0.03). No side effects were recorded. MRI showed marked improvement of shoulder lesions one week after first injection and an almost complete resolution one week after last injection in the responders. CONCLUSION: Shoulder corticosteroid injections seem to be an effective and safe therapy for PMR.

Aged↗
PubMed2001

Factors affecting the accelerated blood clearance of polyethylene glycol-liposomes upon repeated injection.

Previously, we showed that long-circulating polyethylene glycol (PEG)-liposomes are cleared rapidly from the circulation when injected repeatedly in the same animal. In this article, we describe the effects of PEG-coating, the circulation time, the lipid dose, and the presence of encapsulated doxorubicin on the pharmacokinetics upon repeated injection in rats. Furthermore, the role of liver and splenic macrophages was investigated. Liposomes without PEG-coating also showed the so-called "enhanced clearance effect": blood levels at 4 h post injection decreased from 62.8 +/- 13.7% of injected dose (%ID) after the first injection to 0.54 +/- 0.21%ID after the second injection. This decrease was independent of the circulation time of the first dose. Decreasing the first lipid dose of PEG-liposomes to 0.05 micromol/kg still led to enhanced clearance of a second dose of 5 micromol/kg. No changes in pharmacokinetics were observed when the second dose was 50 micromol/kg. When hepatosplenic macrophages were depleted, no enhanced clearance of repeated liposome injections was observed. A dose of doxorubicin containing PEG-liposomes (Doxil), injected 1 week after injection of empty PEG-liposomes, was cleared rapidly from the circulation in rats. Our results indicate that hepatosplenic macrophages play an essential role in the enhanced clearance effect and that the change in pharmacokinetic behavior upon repeated injection is a general characteristic of liposomes, unrelated to the presence of PEG. Therefore, these findings may have a considerable impact on the clinical application of liposomal formulations that are administered repeatedly.

Animals↗
PubMed2003

Increased survival and decreased tumor size due to intratumoral injection of ethanol followed by administration of immature dendritic cells.

Antigen-presenting dendritic cells (DC), loaded in vitro with tumor associated antigens (TAAs), are now used for antitumor therapy. However, little is known about the interaction between DC and TAAs within tumor microenvironment. This study was conducted to evaluate if antitumor immunity can be induced by injecting immature DC into necrotized tumor tissues. A mouse model of colon cancer was established by subcutaneous injection of CMT-93 (a murine colon cancer cell) in the flank of C57BL/6 mice. When the tumors became about 10 mm in diameter, a portion of the tumor nodules was necrotized by injecting 100 micro l of 100% ethanol. Bone marrow-derived immature DC from syngenic mice were injected into the tumors, 48 h after ethanol injection. The size of the tumor and the survival time of the mice were studied. Immunohistochemical methodology was employed to detect injected DC and to evaluate the levels of maturation of DC. Tumor-bearing mice injected with ethanol plus DC survived for longer duration compared to untreated mice (p<0.05). Three weeks after therapy, the sizes of the tumor nodules were reduced compared to untreated mice. Forty-eight hours after injection, the injected DC were detected in the spleen. The stimulatory capacity of spleen DC isolated from mice treated with ethanol plus DC were significantly higher compared to that of untreated mice (p<0.05). Mature DC expressing CD86 were detected in cancer nodule after injecting ethanol plus DC, however, these were almost absent in tumor-bearing mice in situ. Taken together, direct administration of ethanol plus DC in the tumor nodules represents a new therapeutic approach for antitumor immunotherapy.

Animals↗
PubMed2005

[Therapeutic effect of qingkailing and shengmai injection alone or combined on the acute lung injury induced by oleic acid in rabbits].

OBJECTIVE: To investigate the effect of Qingikailing and Shengmai injection alone or combined on the acute lung injury (AL) induced by oleic acid in rabbits. METHOD: The rabbits were randomly divided into 11 groups: oleic acid group; control group; treatment groups including low, middle and high dosage groups of Qingkailing and Shengmai injection alone and combined, respectively. ALI model was established by iv oleic acid (0.05 mL x kg(-1)) in these groups, and then iv above drugs respectively,while in control group, the same volume of normal saline was given. The respiratory amplitude and rate were observed, and blood samples were taken from cervical artery for blood-gas analysis before and at 30, 60, 120 min after oleic acid or normal saline administration. At the end of experiment, the concentration of LDH, CAT and MDA in the lung tissue were measured and pathologic changes of lung tissue were observed microscopically. RESULT: Compared with oleic acid group, the respiratory amplitude markedly enhanced (P < 0.05) in the low and high dose groups of Qingkailing and Shengmai injection. PaO2 increased significantly (P < 0.05) in the low dose group of combined Qingkailing and Shengmai injection, PaCO2 decreased markedly (P < 0.05) in the low dose groups of Qingkailing and Shengmai injection alone and combined. The level of MDA significantly decreased (P < 0.05) in the each group of Qingkailing and Shengmai injection alone, the level of MDA significantly decreased (P < 0.05) and CAT increased (P < 0.05) in the low dose group of combined Qingkailing with Shengmai injection. The low dose group of combined Qingkailing and Shengmai injection can alleviate the pathological changes induced by oleic acid. CONCLUSION: The curative effect of the low dose group of combined Qingkailing with Shengmai injection for the ALI induced by oleic acid was better than Qingkailing and Shengmai injection alone at the same dosage.

Animals↗
PubMed2005

Paraplegia following a thoracolumbar transforaminal epidural steroid injection.

BACKGROUND: In recent years, transforaminal epidural injections have emerged as an alternative to interlaminar and caudal epidural steroid injections. The rationale for utilizing transforaminal epidural injections has been described for diagnostic as well as therapeutic purposes. The evidence for lumbar transforaminal epidural steroid injections in managing lumbar nerve root pain is strong, whereas it is moderate in managing cervical nerve root pain. However, these techniques are also associated with rare, but catastrophic, neurologic complications. OBJECTIVE: To present a case report describing a devastating neurologic injury following a transforaminal thoracolumbar epidural steroid injection. CASE REPORT: A 67-year-old female was referred for treatment of chest wall pain following a T-12 compression fracture. Her pain was primarily radicular in nature. She had not responded to conservative care and continued to suffer from disabling pain. A left T12-L1 transforaminal epidural steroid injection was performed using the "safe triangle" technique; there was appropriate spread of dye that was visualized and recorded as well as a "washout" image. The injectate consisted of a 3 mL volume of 1% ropivacaine and 50 mg triamcinolone acetonide suspension. The patient experienced a rapid and complete loss of sensation and movement below the T-10 level within five minutes after the injection. An MRI initially performed six hours after the procedure was non-diagnostic but an MRI performed two days later confirmed a thoracolumbar spinal cord infarction. High dose intravenous steroids provided during the course of treatment did not significantly alter her neurological deficits and she continues to be paraplegic. CONCLUSION: This case report describes vascular injury leading to an infarction of the spinal cord following a thoracolumbar transforaminal epidural steroid injection. Alternative approaches to, or alternatives means of, performing transforaminal injections should be considered to avoid devastating neurological complications.

Journal Article↗
PubMed2004

Effectiveness of transforaminal epidural steroid injections in patients with degenerative lumbar scoliotic stenosis and radiculopathy.

BACKGROUND: The use of epidural steroid injections as a treatment for patients with degenerative lumbar scoliotic spinal stenosis and radiculopathy has received sparse attention in the literature. Even though it has been reported that patients with scoliosis may respond differently than other patient groups to conservative therapeutic interventions for low back pain and radiculopathy, patients with scoliosis have rarely, if ever, been excluded from clinical studies of epidural steroid injections. To date, there are no studies investigating the efficacy of fluoroscopic transforaminal epidural steroid injections as a treatment for patients with radiculopathy and radiographic evidence of degenerative lumbar scoliotic stenosis. OBJECTIVE: To evaluate the effectiveness of fluoroscopically guided transforaminal epidural steroid injections as a conservative treatment for patients with degenerative lumbar scoliotic stenosis and radiculopathy. DESIGN: Retrospective case series. METHODS: The study was performed in an academic outpatient physical medicine and rehabilitation spine practice. Participants included 61 patients with radiographic evidence of degenerative lumbar scoliotic stenosis and radiculopathy. Patients who had undergone at least one fluoroscopic-guided transforaminal epidural steroid and anesthetic injection were included. MAIN OUTCOME MEASURES: Numeric Rating Scale (NRS) for worst pain experienced, North American Spine Society (NASS) satisfaction scale, amount of pain medication used, and adapted Stucki questionnaire to assess function and pain status. RESULTS: We obtained follow-up on 52 (85.2%) of 61 included patients. We defined a successful outcome as a patient who was both satisfied with his or her results and experienced at least a 2-points improvement in NRS, Summary Pain, and Summary Function scores. Using these criteria for success, 59.6% of our patients had a successful outcome at one week post-injection, 55.8% at one month post-injection, 37.2% at one year post-injection, and 27.3% had a successful outcome at two years post-injection (p < 0.01). CONCLUSION: Fluoroscopic transforaminal epidural steroid injections appear to be an effective nonsurgical treatment option for patients with degenerative lumbar scoliotic stenosis and radiculopathy and should be considered before surgical intervention.

Journal Article↗
PubMed2003

Are fluoroscopic caudal epidural steroid injections effective for managing chronic low back pain?

OBJECTIVE: This study sought to determine the efficacy of fluoroscopic caudal epidural steroid injections as a conservative treatment in patients with presumably chronic lumbar discogenic pain. SUMMARY OF BACKGROUND DATA: Epidural steroid injections have been used in the treatment of lumbar radicular pain with success. However, despite their widespread use, there are few, if any, reports of the efficacy of Epidural steroid injections in patients with predominantly axial lumbar pain. Prior studies have been limited by the use of non-fluoroscopically guided injections and failing to apply a specific injection approach (i.e. transforaminal, interlaminar, or caudal) to a specific patient population. METHODS: Ninety-seven patients with chronic axial low back pain and Magnetic Resonance Imaging evidence of disc pathology without stenosis were selected from chart review. All patients received at least one fluoroscopically guided caudal epidural injection with 12 mg of betamethasone and 8 cc of 0.5% lidocaine. Collected follow-up information included Roland-Morris Disability, Visual Numeric Pain Scale, and patient satisfaction scores. RESULTS: Only nineteen patients (23%) were determined to have a successful long- term (> 1 year) outcome and 65 (77%) were deemed failures. Average follow-up was 28.6 +/- 15.6 months. Successes were found to differ significantly from failures in pre-injection pain scores and patient satisfaction. Overall patient satisfaction was 45%. CONCLUSION: At greater than two year follow-up, the efficacy of fluoroscopically guided caudal epidural steroid injections in patients with chronic lumbar discogenic pain is poor. Patient satisfaction exceeds the reported rate of efficacy. Patients responding to injection have significantly lower pre-injection pain scores.

Journal Article↗