Sample records for intravenous iv therapy

  1. Intravenous therapy

    PubMed Central

    Waitt, C; Waitt, P; Pirmohamed, M

    2004-01-01

    Intravenous administration of fluids, drugs, and nutrition is very common in hospitals. Although insertion of peripheral and central cannulae and subsequent intravenous therapy are usually well tolerated, complications that prolong hospitalisation, and in some cases cause death, can arise on occasions. Additionally, many cannulae are inserted unnecessarily. This article seeks to review this area and to outline good medical practice. PMID:14760169

  2. Induction therapies for class IV lupus nephritis with non-inflammatory necrotizing vasculopathy: mycophenolate mofetil or intravenous cyclophosphamide.

    PubMed

    Wang, J; Hu, W; Xie, H; Zhang, H; Chen, H; Zeng, C; Liu, Z; Li, L

    2007-01-01

    The presence of renal noninflammatory necrotizing vasculopathy (NNV) is often associated with a severe form of lupus nephritis (LN), which is unresponsive to standard therapy. We conducted a 6-month randomized, prospective, open-label trial comparing mycophenolate mofetil (MMF) (1.5-2.0 g/day) with monthly i.v. cyclophosphamide (CTX) (0.75-1.0 g/m2) as induction therapy for class IV LN with NNV. The primary and second end points were complete remission (CR) and partial remission (PR), respectively. Of 20 patients recruited, nine were randomly assigned to MMF and 11 to CTX. The baseline characteristics between groups were not significant. CR was achieved in four patients (44.4%) receiving MMF and in none of the patients receiving CTX (P = 0.026). PR was achieved in two patients (22.2%) in the MMF group and three patients (27.2%) in the CTX group. The total remission rate (CR + PR) in the MMF and CTX group was 66.6 and 27.2%, respectively (P = 0.17). MMF was more effective than i.v. CTX in reducing proteinuria and haematuria. Adverse events were significantly less frequent with MMF than with CTX (P = 0.028). MMF was superior to i.v. CTX in inducing CR of LN with NNV and had a more favourable safety profile. PMID:17728363

  3. Early Intervention of Intravenous KB220IV- Neuroadaptagen Amino-Acid Therapy (NAAT)™ Improves Behavioral Outcomes in a Residential Addiction Treatment Program: A Pilot Study

    PubMed Central

    Miller, Merlene; Chen, Amanda LC; Stokes, Stan D.; Silverman, Susan; Bowirrat, Abdalla; Manka, Matthew; Manka, Debra; Miller, David K.; Perrine, Kenneth; Chen, Thomas JH; Bailey, John A.; Downs, William; Waite, Roger L.; Madigan, Margaret A.; Braverman, Eric R.; Damle, Uma; Kerner, Mallory; Giordano, John; Morse, Siobhan; Oscar-Berman, Marlene; Barh, Debmalya; Blum, Kenneth

    2014-01-01

    Substance use disorders (SUD) are inheritable and the culprit is hypodopaminergic function regulated by reward genes. We evaluated a natural dopaminergic agonist; KB220 intravenous (IV) and oral variants, to improve dopaminergic function in SUD. Our pilot experiment found a significant reduction of chronic symptoms, measured by the Chronic Abstinence Symptom Severity (CASS) Scale. The combined group (IV and oral) did significantly better than the oral-only group over the first week and 30-day follow-up period. Next, the combination was given to129 subjects and three factors; Emotion, Somatic, and Impaired Cognition, with eigenvalues greater than one were extracted for baseline CASS-Revised (CASS-R) variables. Paired sample t-tests for pre and post-treatment scales showed significant declines (p = .00001) from pre- to post-treatment: t = 19.1 for Emotion, t = 16.1 for Somatic, and t = 14.9 for Impaired Cognition. In a two-year follow-up of 23 subjects who underwent KB220IV therapy (at least five IV treatments over seven days) plus orals for 30+ days: 21 (91%) were sober at six months, 19 (82%) having no relapse; 19 (82%) were sober at one year, 18 (78%) having no relapse; and 21 (91%) were sober two-years post-treatment, 16 (70%) having no relapse. We await additional research and advise caution in interpreting these encouraging results. PMID:23457891

  4. Home intravenous therapy: Part I--Issues.

    PubMed

    McAbee, R R; Grupp, K; Horn, B

    1991-01-01

    Concerns related to providing home intravenous therapy were among the top ten clinical problems identified by Northwest Medicare-certified home care agencies in a 1986 survey. This paper addresses issues related to home intravenous therapy and provides lists of resources for the development of home intravenous therapy programs. Part I of the paper covers concerns related to intravenous therapy as expressed by home care agencies in the Northwest and synthesized the literature about home intravenous therapies. Survey results are presented, followed by a discussion of client and caregiver concerns. These include: discharge planning, client admission criteria and client and caregiver education. Standards, staffing, and staff education issues are discussed followed by sections on economics, marketing regulations and legal and ethical concerns. Finally, there is a discussion of issues related to specific types of intravenous therapies: parenteral nutrition, antibiotic therapy; chemotherapy; blood and blood component therapy and other less frequently used types of intravenous therapies. Each therapy is discussed with regard to complications, client and caregiver instruction and financial considerations. Part II of the paper is a resource guide which lists resources that agencies may use to develop a home intravenous therapy program. In the first section, national organizations and journals and books concerned with intravenous therapy are listed as well as journal articles, guidelines and guidebooks and client and provider educational materials. National and regional product and service representatives of intravenous therapy related companies are also listed. In the second section, addresses for the State Boards of Nursing are given for Alaska, Idaho, Montana, Oregon and Washington. Each state section includes a list of those agencies who indicated in the 1988 survey that they would be willing to share materials. In addition, product and service vendors of intravenous therapy supplies and equipment are listed for the State of Washington. PMID:10116313

  5. Intravenous Fluid Therapy Course for the Licensed Practical Nurse. Instructor Guide.

    ERIC Educational Resources Information Center

    Missouri Univ., Columbia. Instructional Materials Lab.

    This curriculum guide provides materials for a 10-unit intravenous (IV) therapy course for licensed practical nurses. Units contain from one to nine lessons. The first unit provides an introduction and orientation to the course. Subsequent units concern documentation, anatomy and physiology as applied to IV therapy, fundamental aspects of fluid…

  6. Intravenous immunoglobulin therapy for refractory recurrent pericarditis.

    PubMed

    del Fresno, M Rosa; Peralta, Julio E; Granados, Miguel Ángel; Enríquez, Eugenia; Domínguez-Pinilla, Nerea; de Inocencio, Jaime

    2014-11-01

    Recurrent pericarditis is a troublesome complication of idiopathic acute pericarditis and occurs more frequently in pediatric patients after cardiac surgery (postpericardiotomy syndrome). Conventional treatment with nonsteroidal antiinflammatory drugs, corticosteroids, and colchicine is not always effective or may cause serious adverse effects. There is no consensus, however, on how to proceed in those patients whose disease is refractory to conventional therapy. In such cases, human intravenous immunoglobulin, immunosuppressive drugs, and biological agents have been used. In this report we describe 2 patients with refractory recurrent pericarditis after cardiac surgery who were successfully treated with 3 and 5 monthly high-dose (2 g/kg) intravenous immunoglobulin until resolution of the effusion. Our experience supports the effectiveness and safety of this therapy. PMID:25287461

  7. Efficacy and Safety of Intravenous Iron Therapy for HCV-Positive Haemodialysis Patients

    Microsoft Academic Search

    Serkan Kahraman; Rahmi Yilmaz; Gultekin Genctoy; Mustafa Arici; Bulent Altun; Yunus Erdem; Unal Yasavul; Cetin Turgan

    2005-01-01

    Background: Iron supplementation is the cornerstone of anaemia management in haemodialysis (HD) patients. However, efficacy and safety of intravenous (IV) iron therapy in hepatitis C virus (HCV)-positive HD patients is yet to be elucidated. Methods: Sixty-six maintenance HD patients with suboptimal response to recombinant human erythropoietin (rh-EPO) were administered IV iron. Each patient received 100 mg\\/session IV iron sucrose for

  8. Intravenous immunoglobulin therapy in proximal diabetic neuropathy

    PubMed Central

    Kawagashira, Yuichi; Watanabe, Hirohisa; Oki, Yumiko; Iijima, Masahiro; Koike, Haruki; Hattori, Naoki; Katsuno, Masahisa; Tanaka, Fumiaki; Sobue, Gen

    2009-01-01

    A 57-year-old man with type 2 diabetes mellitus for 10 years showed progressive loss of muscle strength in both legs, pain and muscle atrophy in the femoral region and significant weight loss. On admission, he could not stand alone and used a wheelchair. He also complained of severe pain in the lower extremities. He was diagnosed with proximal diabetic neuropathy (PDN) by characteristic clinical and electrophysiological features. Intravenous immunoglobulin therapy (IVIg 0.4 g/kg×5 days) markedly reduced the severe pain and muscle weakness in the legs. Eventually, pain assessed by the Visual Analogue Scale was relieved by 80% and muscle strength was also well recovered, thereby enabling the patient to walk with a cane. The present case suggests that IVIg therapy may be effective for the relief of pain in PDN. PMID:21686696

  9. Intravenous clomipramine challenge in obsessive-compulsive disorder: predicting response to oral therapy at eight weeks

    Microsoft Academic Search

    Floyd R Sallee; Lorrin M Koran; Stefano Pallanti; Stanley W Carson; Gopalan Sethuraman

    1998-01-01

    Background: Challenge with intravenous clomipramine (CMI) is serotonin selective and has been reported to transiently exacerbate symptoms in obsessive-compulsive disorder (OCD) patients, and to predict subsequent response to oral CMI therapy.Methods: We administered CMI (12.5 mg, IV) to medication free OCD patients (N = 29) and normal controls (N = 22) to characterize neurohormonal response. A subset of OCD patients

  10. Switch over from intravenous to oral therapy: A concise overview

    PubMed Central

    Cyriac, Jissa Maria; James, Emmanuel

    2014-01-01

    Majority of the patients admitted to a hospital with severe infections are initially started with intravenous medications. Short intravenous course of therapy for 2-3 days followed by oral medications for the remainder of the course is found to be beneficial to many patients. This switch over from intravenous to oral therapy is widely practiced in the case of antibiotics in many developed countries. Even though intravenous to oral therapy conversion is inappropriate for a patient who is critically ill or who has inability to absorb oral medications, every hospital will have a certain number of patients who are eligible for switch over from intravenous to oral therapy. Among the various routes of administration of medications, oral administration is considered to be the most acceptable and economical method of administration. The main obstacle limiting intravenous to oral conversion is the belief that oral medications do not achieve the same bioavailability as that of intravenous medications and that the same agent must be used both intravenously and orally. The advent of newer, more potent or broad spectrum oral agents that achieve higher and more consistent serum and tissue concentration has paved the way for the popularity of intravenous to oral medication conversion. In this review, the advantages of intravenous to oral switch over therapy, the various methods of intravenous to oral conversion, bioavailability of various oral medications for the switch over program, the patient selection criteria for conversion from parenteral to oral route and application of intravenous to oral switch over through case studies are exemplified. PMID:24799810

  11. Factors influencing response to intravenous lacosamide in emergency situations: LACO-IV study.

    PubMed

    Garcés, Mercedes; Villanueva, Vicente; Mauri, José Angel; Suller, Ana; García, Carolina; López González, Franscisco Javier; Rodríguez Osorio, Xiana; Fernández Pajarín, Gustavo; Piera, Anna; Guillamón, Edelmira; Santafé, Consuelo; Castillo, Ascensión; Giner, Pau; Torres, Nerea; Escalza, Inés; Del Villar, Ana; García de Casasola, Maria Carmen; Bonet, Macarena; Noé, Enrique; Olmedilla, Nuria

    2014-07-01

    Status epilepticus (SE) and acute repetitive seizures (ARSs) frequently result in emergency visits. Wide variations in response are seen with standard antiepileptic drugs (AEDs). Oral and intravenous (IV) formulations of lacosamide are approved as adjunctive therapy in the treatment of partial-onset seizures in adults and adolescents. The aim of the retrospective multicenter observational study (LACO-IV) was to analyze data from a large cohort of patients with SE or ARSs of varying severity and etiology, who received IV lacosamide in the emergency setting. Patient clinical data were entered into a database; lacosamide use and efficacy and tolerability variables were analyzed. In SE, IV lacosamide tended to be used mainly in nonconvulsive status epilepticus as second- or third-line treatment. The proportion of patients with no seizures when IV lacosamide was the last drug administered was 76.5% (70.9% SE and 83.7% ARSs). The rate of seizure cessation ? 24 h after IV lacosamide administration was 57.1% (49.1% SE and 67.4% ARSs). Of the factors analyzed, a shorter latency from seizure onset to IV lacosamide infusion influenced treatment response significantly. A nonsignificant tendency towards a higher response was seen with lacosamide dose >200mg versus ? 200 mg. Analysis of response according to mechanism of action showed no significant differences in response to IV lacosamide in patients receiving prior sodium channel blocker (SCB) or non-SCB AEDs in the overall or SE population; however, in ARSs, a tendency towards a higher response was observed in those receiving non-SCB AEDs. The frequency and nature of adverse events observed were in line with those reported in other studies (somnolence being the most frequent). In the absence of randomized prospective controlled studies of IV lacosamide, our observations suggest that IV lacosamide may be a potential alternative for treatment of SE/ARSs when seizures fail to improve with standard AEDs or when AEDs are contraindicated or not recommended. PMID:24922617

  12. Comparative Study between Intravenous and Intraperitoneal Stem Cell Therapy in Amiodarone Induced Lung Injury in Rat

    PubMed Central

    Zickri, Maha Baligh; Fadl, Sahar Gamal Aboul; Metwally, Hala Gabr

    2014-01-01

    Background and Objectives: The fibrosing form of lung injury (occupational, environmental, infective or drug induced) is associated with significant morbidity and mortality. Amiodarone (AM), often prescribed for control of arrhythmias is considered a potential cause. No effective treatment was confirmed, except lung transplantation. Intravenous (IV) stem cell therapy may produce pulmonary emboli or infarctions. Despite being commonly used in clinical practice, the intraperitoneal (IP.) route has been rarely used for cell delivery. The present study aimed at investigating and comparing the possible effect of IP stem cell therapy (SCT) on pulmonary toxicity versus the intravenous route in a rat model of amiodarone induced lung damage. Methods and Results: 36 adult male albino rats were divided into 4 groups. Rats of AM group were given 30 mg/kg daily orally for 4 weeks. Rats of IV SCT group were injected with stem cells in the tail vein. Rats of IP SCT group received IP cell therapy. Histological, histochemical, immunohistochemical and morphometric studies were performed. Obstructed bronchioles, overdistended alveoli, reduced type I pneumocytes, increased thickness of alveolar septa and vessels wall besides increased area% of collagen fibers regressed in response to IV and IP SCT. The improvement was more obvious in IV group. The area% of Prussion blue +ve and CD105 +ve cells was significantly higher in IV group. Conclusions: Cord blood MSC therapy proved definite amelioration of lung injury ending in fibrosis. The effect of IP SCT was slightly inferior to that of IV SCT, which may be overwhelmed by repeated IP injection. PMID:24921022

  13. Intravenous nutrient therapy: the "Myers' cocktail".

    PubMed

    Gaby, Alan R

    2002-10-01

    Building on the work of the late John Myers, MD, the author has used an intravenous vitamin-and-mineral formula for the treatment of a wide range of clinical conditions. The modified "Myers' cocktail," which consists of magnesium, calcium, B vitamins, and vitamin C, has been found to be effective against acute asthma attacks, migraines, fatigue (including chronic fatigue syndrome), fibromyalgia, acute muscle spasm, upper respiratory tract infections, chronic sinusitis, seasonal allergic rhinitis, cardiovascular disease, and other disorders. This paper presents a rationale for the therapeutic use of intravenous nutrients, reviews the relevant published clinical research, describes the author's clinical experiences, and discusses potential side effects and precautions. PMID:12410623

  14. Intravenous iron therapy: well-tolerated, yet not harmless.

    PubMed

    Sengölge, G; Hörl, W H; Sunder-Plassmann, G

    2005-12-01

    In the majority of patients with chronic renal failure, it is essential to substitute erythropoietic agents and iron to maintain a haemoglobin level above 11 g dL-1. Intravenous iron is more effective than oral iron. Substitution of intravenous iron is mainly performed using iron(III)-hydroxide-sucrose complex (iron sucrose) and iron(III)-sodium-gluconate in sucrose (iron gluconate), and is, in general, well-tolerated. Nonetheless, intravenous iron therapy has effects on endothelial cells, polymorphonuclear leucocytes and cytokines which are most likely related to non-transferrin bound labile iron. These effects suggest a role of iron in infection or atherosclerosis. Yet, not all available data support the association of iron with infection and atherosclerosis. A recent trial showed that iron sucrose is safe when given as treatment for iron deficiency or for maintenance of iron stores. Nevertheless, iron therapy should be handled with caution but its use should not be feared whenever indicated. PMID:16281958

  15. Oral versus intravenous rehydration therapy in severe gastroenteritis.

    PubMed Central

    Sharifi, J; Ghavami, F; Nowrouzi, Z; Fouladvand, B; Malek, M; Rezaeian, M; Emami, M

    1985-01-01

    A controlled, randomised trial comparing the results of oral rehydration therapy with those of intravenous fluid treatment in 470 children with severe gastroenteritis was undertaken. The oral rehydration therapy was divided into two phases--a rehydration phase that used high sodium isotonic fluid at 40 ml/kg per hour and a maintenance phase using low sodium isotonic fluid (sodium 40, potassium 30, bicarbonate 25, chloride 45, and dextrose 130 mmol/l). The results indicate that oral rehydration treatment, used according to this protocol, is successful in treating severe diarrhoea and dehydration, and has considerable advantages over intravenous fluid therapy in reducing complications associated with the treatment of hypernatraemia, in promoting rapid correction of hypokalaemia and acidosis, in decreasing the duration of diarrhoea, and in promoting a greater weight gain at hospital discharge. PMID:3901934

  16. [Hepatocellular carcinoma following intravenous thorium X therapy].

    PubMed

    Madeya, S; Labenz, J; Breining, H; Peitz, U; Korth, J; Börsch, G

    1994-05-01

    Twelve years after receiving radiation therapy with thorium X (280 microCi) for long-standing Bechterew's disease (ankylosing spondylitis) a 52-year-old man was found, by ultrasonography and computed tomography, to have a round mass, 11 x 12 cm, in the left lobe of the liver. Laparoscopy discovered coarse, discoloured nodes on the surface of the right and left lobes of the liver which histologically showed hepatocellular carcinoma. There were no known risk factor for liver carcinoma (like cirrhosis, positive hepatitis B serology, alcohol abuse, haemochromatosis or alpha 1-antitrypsin deficiency). As exploratory laparotomy found the tumour to be inoperable, 15 chemotherapeutic embolizations were performed. An abdominal wall metastasis was resected after 17 months. At the time of this report, 20 months after the diagnosis was first made, the patient is in a poor general condition. Internal radiotherapy with thorium X was used, all else having failed, in the treatment of severe ankylosing spondylitis. Although it is not possible to prove a direct causal relationship between the thorium X radiation and development of a liver carcinoma, the coincidence is remarkable. PMID:8187611

  17. Intravenous Allogeneic Adipose-derived Mesenchymal Stem Cell Treatment of Stage IV Chronic Kidney Disease Cats

    E-print Network

    Collett Jr., Jeffrey L.

    Intravenous Allogeneic Adipose-derived Mesenchymal Stem Cell Treatment of Stage IV Chronic Kidney Road, Fort Collins, CO 80523 Client ID Client Information ­ What is the study about? Chronic kidney there is no definitive treatment. Currently, other than kidney transplantation, only supportive care home treatments

  18. Combined Intravenous and Intra-Arterial r-TPA Versus Intra-Arterial Therapy of Acute Ischemic Stroke Emergency Management of Stroke (EMS) Bridging Trial

    Microsoft Academic Search

    Christopher A. Lewandowski; Michael Frankel; Thomas A. Tomsick; Joseph Broderick; James Frey; Wayne Clark; Sidney Starkman; James Grotta; Judith Spilker; Jane Khoury; Thomas Brott

    Background and Purpose—The purpose of this study was to test the feasibility, efficacy, and safety of combined intravenous (IV) and local intra-arterial (IA) recombinant tissue plasminogen activator (r-TPA) therapy for stroke within 3 hours of onset of symptoms. Methods—This was a double-blind, randomized, placebo-controlled multi-center Phase I study of IV r-TPA or IV placebo followed by immediate cerebral arteriography and

  19. Clinical outcomes of intravenous immunoglobulin therapy in refractory uveitis.

    PubMed

    Garcia-Geremias, M; Carreño, E; Epps, S J; Lee, R W J; Dick, A D

    2015-04-01

    Intravenous immunoglobulin (IVIg) therapy has multiple mechanisms of immunomodulatory action. We wished therefore to assess its efficacy in a spectrum of patients with refractory uveitis. Retrospective review of clinical charts was conducted to document response to IVIg treatment in consecutive patients with treatment-refractory uveitis. Main outcome measures were control of intraocular inflammation, visual acuity, progression of the disease, and complications. Four (two male) patients, with a mean age at the beginning of the treatment of 47 years (range: 39-64), were included in the study. Indication for treatment was patients with active non-infectious uveitis refractory to steroids and immunomodulatory therapy. All patients received a course of 0.5 g/kg per day of IVIg for three consecutive days, repeating this course at a mean of 11 week (range: 2-39 weeks) intervals when indicated clinically. The median duration of the IVIg therapy was 7 months (range: 3-14 months). In three patients treatment resulted in stabilisation and prevention of progression of the disease, and additionally in two patients it facilitated a decrease in prednisolone dose. Treatment failed to induce long-term remission in one patient with recurrence of macular oedema. IVIg was well tolerated with neither immediate nor longer-term adverse events observed. In three out of four cases IVIg was an effective adjunctive therapy and well tolerated for the management of treatment-refractory uveitis. PMID:25708281

  20. Intravenous Iron Sucrose for Children with Iron Deficiency Failing to Respond to Oral Iron Therapy

    PubMed Central

    Crary, Shelley E.; Hall, Katherine; Buchanan, George R.

    2010-01-01

    Background For decades parenteral iron has been used in patients with iron deficiency unresponsive to oral iron therapy and in hemodialysis-dependent patients receiving erythropoietin. Newer intravenous (IV) iron formulations such as iron sucrose have replaced high molecular weight iron dextran in dialysis patients; however, the use of parenteral iron in children without renal disease has not been well defined. Procedure Pharmacy records were reviewed on children (? 18 yrs of age) who received IV iron sucrose at Children's Medical Center Dallas between January 1, 2004 and June 30, 2009. Patients who received iron sucrose for chronic renal disease were excluded from analysis. Results Thirty-eight children received iron sucrose for non-renal indications, 13 with iron deficiency refractory to oral iron therapy, 13 with iron malabsorption or dependence on parenteral nutrition, 7 for chronic gastrointestinal blood loss, and 5 for miscellaneous indications. Among these 38 children, who received a total of 510 doses of IV iron sucrose, there were only 6 adverse reactions. Patients in all categories had a good response to the iron sucrose, with a median hemoglobin rise of 1.9 – 3.1 g/dl depending on the indication. Conclusions Parenteral iron is a safe and effective means to treat iron deficiency in children who cannot receive or do not respond to oral iron due to intolerance, poor adherence or iron malabsorption. PMID:21298748

  1. Early intensified intravenous cyclosporine therapy predicts favorable response to immunosuppressive therapy with rabbit antithymocyte globulin in patients with severe aplastic anemia.

    PubMed

    Song, Moo-Kon; Chung, Joo-Seop; Joo, Young-Don; Lee, Gyeong-Won; Hong, Junshik; Park, Sang-Hyuk; Shin, Ho-Jin

    2015-03-01

    Because of relapse after horse ATG (hATG) therapy, rabbit ATG (rATG) would be a realistic alternative as second line immunosuppressive therapy (IST) in severe aplastic anemia (SAA) patients. We investigated whether intensified intravenous (IV) CsA therapy with rATG would increase the response of IST in SAA patients. Sixty-one of the 123 patients received IV CsA therapy with rATG during initial 2 weeks then changed to oral form (IV CsA group), while other 62 patients just received oral CsA therapy with rATG (oral CsA group). Hematologic response rates at 3 and 6 months were not different between IV CsA group and oral CsA group (p=0.795, p=0.079). However, CsA levels during initial 15 days were higher in response-achieved group than response-not-achieved group. Intensive IV CsA group maintained CsA level ?300ng/ml during 15 days had higher responses at 6 months than non-intensive IV CsA group and oral CsA group (p=0.009, p=0.021). Intensive IV CsA group (HR=3.239, 95% CI=1.095-8.997, p=0.013) independently predicted favorable the hematologic response at 6 months of IST. Early intensified CsA therapy was important to achieve favorable outcomes in IST including rATG. PMID:25563075

  2. Schedule Dependence in Cancer Therapy: Intravenous Vitamin C and the Systemic Saturation Hypothesis

    PubMed Central

    Miranda Massari, Jorge R.; Duconge, Jorge; Riordan, Neil H.; Ichim, Thomas

    2013-01-01

    Despite the significant number of in vitro and in vivo studies to assess vitamin C effects on cancer following the application of large doses and its extensive use by alternative medicine practitioners in the USA; the precise schedule for successful cancer therapy is still unknown. Based on interpretation of the available data, we postulate that the relationship between Vitamin C doses and plasma concentration x time, the capability of tissue stores upon distribution, and the saturable mechanism of urinary excretion are all important determinants to understand the physiology of high intravenous vitamin C dose administration and its effect on cancer. Practitioners should pay more attention to the cumulative vitamin C effect instead of the vitamin C concentrations to account for observed discrepancy in antitumor response. We suggest that multiple, intermittent, short-term intravenous infusions of vitamin C over a longer time period will correlate with greater antitumor effects than do single continuous IV doses of the same total exposure. This approach would be expected to minimize saturation of renal reabsorption, providing a continuous “dynamic flow” of vitamin C in the body for optimal systemic exposure and clinical outcomes. This prevents the “systemic saturation” phenomena, which may recycle vitamin C and render it less effective as an anticancer agent. Nonetheless, more pharmacokinetic and pharmacodynamic studies are needed to fully understand this schedule-dependence phenomenon. PMID:24860238

  3. Schedule Dependence in Cancer Therapy: Intravenous Vitamin C and the Systemic Saturation Hypothesis.

    PubMed

    Gonzalez, Michael J; Miranda Massari, Jorge R; Duconge, Jorge; Riordan, Neil H; Ichim, Thomas

    2012-01-01

    Despite the significant number of in vitro and in vivo studies to assess vitamin C effects on cancer following the application of large doses and its extensive use by alternative medicine practitioners in the USA; the precise schedule for successful cancer therapy is still unknown. Based on interpretation of the available data, we postulate that the relationship between Vitamin C doses and plasma concentration x time, the capability of tissue stores upon distribution, and the saturable mechanism of urinary excretion are all important determinants to understand the physiology of high intravenous vitamin C dose administration and its effect on cancer. Practitioners should pay more attention to the cumulative vitamin C effect instead of the vitamin C concentrations to account for observed discrepancy in antitumor response. We suggest that multiple, intermittent, short-term intravenous infusions of vitamin C over a longer time period will correlate with greater antitumor effects than do single continuous IV doses of the same total exposure. This approach would be expected to minimize saturation of renal reabsorption, providing a continuous "dynamic flow" of vitamin C in the body for optimal systemic exposure and clinical outcomes. This prevents the "systemic saturation" phenomena, which may recycle vitamin C and render it less effective as an anticancer agent. Nonetheless, more pharmacokinetic and pharmacodynamic studies are needed to fully understand this schedule-dependence phenomenon. PMID:24860238

  4. Intravenous tPA Therapy is an Independent Risk Factor for Symptomatic Intracerebral Hemorrhage Following Carotid Endarterectomy

    PubMed Central

    Vellimana, Ananth K.; Yarbrough, Chester K.; Blackburn, Spiros; Strom, Russell G.; Pilgram, Thomas K.; Lee, Jin-Moo; Grubb, Robert L.; Rich, Keith M.; Chicoine, Michael R.; Dacey, Ralph G.; Derdeyn, Colin P.; Zipfel, Gregory J.

    2014-01-01

    Objective Carotid endarterectomy (CEA) for symptomatic carotid artery stenosis and intravenous tPA (IV-tPA) for acute ischemic stroke are proven therapies; however, the safety of CEA in stroke patients who recently received IV-tPA has not been established. Methods We performed a retrospective review of a consecutive series of patients who underwent CEA for symptomatic carotid artery stenosis. The primary safety endpoint was post-operative symptomatic intracerebral hemorrhage (sICH). A univariate analysis of potential risk factors for sICH including IV-tPA therapy, timing of CEA, degree of arterial stenosis, and severity of presenting ischemic stroke was performed. Factors with p<0.1 on univariate analysis were tested with multivariate logistic regression. Results The cohort included 142 patients. Three suffered sICH following CEA – 2 of 11 patients treated with IV-tPA (18.2%) and 1 of 131 patients not treated with IV-tPA (0.8%). Both IV-tPA patients suffering sICH underwent CEA within 3 days of tPA administration. On univariate analysis, IV-tPA (p = 0.02), female gender (p=0.09), shorter time between ischemic event and CEA (p=0.06), and lower mean arterial pressure during the first 48 hours of admission (p=0.08) were identified as potential risk factors for sICH. On multivariate analysis, IV-tPA was the only significant risk factor (p=0.002 by stepwise backward elimination logistic regression; p=0.03 by nominal logistic regression). Conclusion Based on this case series, IV-tPA is an independent risk factor for sICH following CEA. This suggests that CEA should be pursued cautiously in patients who recently received IV-tPA. Early surgery may be associated with an increased risk for sICH. PMID:24335814

  5. Intravenous iron therapy: how far have we come?

    PubMed Central

    Cançado, Rodolfo Delfini; Muñoz, Manuel

    2011-01-01

    Oral iron supplementation is usually the first choice for the treatment of iron deficiency anemia (IDA) because of its effectiveness and low cost. But unfortunately in many iron deficient conditions, oral iron is a less than the ideal treatment mainly because of adverse events related to the gastrointestinal tract as well as the long course required to treat anemia and replenish body iron stores. The first iron product for intravenous use was high-molecular-weight iron dextran. However, dextran-containing intravenous iron preparations are associated with an elevated risk of anaphylactic reactions, which made physicians reluctant to prescribe intravenous iron in the treatment of iron deficiency anemia for many years. In 1999 and 2001, two new intravenous iron preparations (ferric gluconate and iron sucrose) were introduced into the market as safer alternatives to iron dextran. Over the last five years, three new intravenous iron dextran-free preparations have been developed and have better safety profiles than the more traditional intravenous compounds, as none require test doses and all these products are promising in respect to a more rapid replacement of body iron stores (15-60 minutes/infusion) as they can be given at higher doses (from 500 mg to more than 1000 mg/infusion). The purpose of this review is to discuss some pertinent issues in relation to the history, pharmacology, administration, efficacy, safety profile and toxicity of intravenous iron for the treatment of iron deficiency anemia. PMID:23049364

  6. Long-Term Efficacy of Postpartum Intravenous Iron Therapy

    PubMed Central

    Zimmermann, Roland

    2014-01-01

    Background. The potential benefits of administering a dose of intravenous iron in patients with moderate postpartum anaemia rather than oral iron alone remains unproven. Aims. To determine whether a single injection of intravenous iron followed by a 6-week course of oral iron is as effective over 6 months in restoring normal haemoglobin levels and replenishing iron stores in women with moderate postpartum anaemia as a course of oral iron alone in women with mild postpartum anaemia. Materials and Methods. Retrospective two-arm cohort study in women with mild postpartum anaemia (haemoglobin 9.6–10.5?g/dL) prescribed iron daily for 6 weeks (N = 150) and women with moderate postpartum anaemia (haemoglobin 8.5–9.5?g/dL), given a single 500?mg injection of intravenous iron followed by iron daily for 6 weeks (N = 75). Haemoglobin and ferritin were measured 6 months postpartum. Results. Haemoglobin returned to similar mean levels in both groups. Ferritin levels were statistically significantly higher in the intravenous + oral group (57.7 ± 49.3??g/L versus 32.9 ± 20.1??g/L). Conclusions. Despite lower baseline haemoglobin, intravenous iron carboxymaltose was superior to oral iron alone in replenishing iron stores in moderate postpartum anaemia and may prove similarly beneficial in mild postpartum anaemia. PMID:25431768

  7. Intravenous Ulinastatin Therapy for Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Pediatric Patients

    Microsoft Academic Search

    Yasuji Inamo; Takahiro Okubo; Mika Wada; Sachiko Fuchigami; Kouji Hashimoto; Tatsuo Fuchigami; Shigeru Takahashi; Shigemasa Sawada; Kensuke Harada

    2002-01-01

    Background: More effective therapy is needed for the treatment of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). The clinical efficacy of intravenous ulinastatin therapy was investigated in 3 Japanese pediatric patients with SJS or TEN. Methods: Ulinastatin was given to 1 pediatric SJS patient and 2 pediatric TEN patients within 7 days (patient 1; SJS), 6 days (patient 2;

  8. Acute hyperkalemia associated with intravenous epsilon-aminocaproic acid therapy

    Microsoft Academic Search

    Mark A. Perazella; Purba Biswas

    1999-01-01

    Epsilon-aminocaproic acid (Amicar) is used to treat severe hemorrhage refractory to usual medical management. This antifibrinolytic drug has been associated with a number of renal complications. However, there are no descriptions of this medication causing hyperkalemia. This report describes the development of hyperkalemia in a patient with underlying chronic renal insufficiency treated with intravenous epsilon-aminocaproic acid. The patient, who underwent

  9. Undergraduate medical textbooks do not provide adequate information on intravenous fluid therapy: a systematic survey and suggestions for improvement

    PubMed Central

    2014-01-01

    Background Inappropriate prescribing of intravenous (IV) fluid, particularly 0.9% sodium chloride, causes post-operative complications. Fluid prescription is often left to junior medical staff and is frequently poorly managed. One reason for poor intravenous fluid prescribing practices could be inadequate coverage of this topic in the textbooks that are used. Methods We formulated a comprehensive set of topics, related to important common clinical situations involving IV fluid therapy, (routine fluid replacement, fluid loss, fluids overload) to assess the adequacy of textbooks in common use. We assessed 29 medical textbooks widely available to students in the UK, scoring the presence of information provided by each book on each of the topics. The scores indicated how fully the topics were considered: not at all, partly, and adequately. No attempt was made to judge the quality of the information, because there is no consensus on these topics. Results The maximum score that a book could achieve was 52. Three of the topics we chose were not considered by any of the books. Discounting these topics as “too esoteric”, the maximum possible score became 46. One textbook gained a score of 45, but the general score was poor (median 11, quartiles 4, 21). In particular, coverage of routine postoperative management was inadequate. Conclusions Textbooks for undergraduates cover the topic of intravenous therapy badly, which may partly explain the poor knowledge and performance of junior doctors in this important field. Systematic revision of current textbooks might improve knowledge and practice by junior doctors. Careful definition of the remit and content of textbooks should be applied more widely to ensure quality and “fitness for purpose”, and avoid omission of vital knowledge. PMID:24555812

  10. The use of 8 cm midlines in community IV therapy.

    PubMed

    Owen, Kate

    2014-10-22

    There is limited published literature on the use of 8 cm centimetre midlines for vascular access. This clinical audit was undertaken to provide a local evidence base for the insertion of midlines in patients receiving non-vesicant intravenous antibiotic therapy in the community setting over the medium term. The findings show their use has clear advantages for patients and clinicians. Although conducted in the community setting, the audit could be replicated in any community or hospital environment where medium-term intravenous therapy of non-vesicant fluids is administered. PMID:25345478

  11. Endovascular Therapy after Intravenous t-PA versus t-PA Alone for Stroke

    PubMed Central

    Broderick, Joseph P.; Palesch, Yuko Y.; Demchuk, Andrew M.; Yeatts, Sharon D.; Khatri, Pooja; Hill, Michael D.; Jauch, Edward C.; Jovin, Tudor G.; Yan, Bernard; Silver, Frank L.; von Kummer, Rüdiger; Molina, Carlos A.; Demaerschalk, Bart M.; Budzik, Ronald; Clark, Wayne M.; Zaidat, Osama O.; Malisch, Tim W.; Goyal, Mayank; Schonewille, Wouter J.; Mazighi, Mikael; Engelter, Stefan T.; Anderson, Craig; Spilker, Judith; Carrozzella, Janice; Ryckborst, Karla J.; Janis, L. Scott; Martin, Renée H.; Foster, Lydia D.; Tomsick, Thomas A.

    2013-01-01

    BACKGROUND Endovascular therapy is increasingly used after the administration of intravenous tissue plasminogen activator (t-PA) for patients with moderate-to-severe acute ischemic stroke, but whether a combined approach is more effective than intravenous t-PA alone is uncertain. METHODS We randomly assigned eligible patients who had received intravenous t-PA within 3 hours after symptom onset to receive additional endovascular therapy or intravenous t-PA alone, in a 2:1 ratio. The primary outcome measure was a modified Rankin scale score of 2 or less (indicating functional independence) at 90 days (scores range from 0 to 6, with higher scores indicating greater disability). RESULTS The study was stopped early because of futility after 656 participants had undergone randomization (434 patients to endovascular therapy and 222 to intravenous t-PA alone). The proportion of participants with a modified Rankin score of 2 or less at 90 days did not differ significantly according to treatment (40.8% with endovascular therapy and 38.7% with intravenous t-PA; absolute adjusted difference, 1.5 percentage points; 95% confidence interval [CI], ?6.1 to 9.1, with adjustment for the National Institutes of Health Stroke Scale [NIHSS] score [8–19, indicating moderately severe stroke, or ?20, indicating severe stroke]), nor were there significant differences for the predefined subgroups of patients with an NIHSS score of 20 or higher (6.8 percentage points; 95% CI, ?4.4 to 18.1) and those with a score of 19 or lower (?1.0 percentage point; 95% CI, ?10.8 to 8.8). Findings in the endovascular-therapy and intravenous t-PA groups were similar for mortality at 90 days (19.1% and 21.6%, respectively; P = 0.52) and the proportion of patients with symptomatic intracerebral hemorrhage within 30 hours after initiation of t-PA (6.2% and 5.9%, respectively; P = 0.83). CONCLUSIONS The trial showed similar safety outcomes and no significant difference in functional independence with endovascular therapy after intravenous t-PA, as compared with intravenous t-PA alone. (Funded by the National Institutes of Health and others; ClinicalTrials.gov number, NCT00359424.) PMID:23390923

  12. Propylene glycol-induced side effects during intravenous nitroglycerin therapy

    Microsoft Academic Search

    H. E. Demey; R. A. Daelemans; G. A. Verpooten; M. E. Broe; Ch. M. Campenhout; F. V. Lakiere; P. J. Schepens; L. L. Bossaert

    1988-01-01

    Propylene glycol, an alcohol frequently used as a solvent in medical preparations, is considered non-toxic. We found that this solvent, used in a commercially available IV nitroglycerin solution, may cause hyperosmolality, hemolysis and lactic acidosis. The influence of kidney function as the main determinant in causing accumulation of this solvent and consequently hyperosmolality is emphasized. A review of the literature

  13. Significant errors and misdirection in class IV laser therapy study.

    PubMed

    Carroll, James D

    2014-04-01

    This Correspondence relates to the article by Ottaviani et al (Effect of Class IV Laser Therapy on Chemotherapy-Induced Oral Mucositis: A Clinical and Experimental Study. Am J Pathol 2013, 183:1747-1757.). PMID:24655380

  14. [A case of primary erythromelalgia successfully treated with high-dose intravenous immunoglobulin therapy].

    PubMed

    Kuroda, Takeshi; Sugimoto, Azusa; Ishigaki, Seiichirou; Murakami, Hidetomo; Kawamura, Mitsuru

    2014-02-01

    Erythromelalgia is a rare condition characterized by constant or paroxysmal burning pain, erythema, and the elevation of skin temperature in the extremities. Recently, the impairment of C-fiber function due to autoimmune system involvement is considered as the primary cause of erythromelalgia. However, a successful treatment has yet not been established. We report a case of a 39-year-old woman with primary erythromelalgia accompanied by high cerebrospinal fluid protein concentration and axonal neuropathy. She received various antiepileptic and anti-inflammatory drugs, but failed to improve. She finally underwent high-dose intravenous immunoglobulin therapy, which dramatically improved her symptoms and normalized cerebrospinal fluid protein concentration. This result demonstrates the effectiveness of high-dose intravenous immunoglobulin therapy for the treatment of primary erythromelalgia and the possibility of autoimmune system involvement. PMID:24523317

  15. Intravenous thrombolysis or endovascular therapy for acute ischemic stroke associated with cervical internal carotid artery occlusion: the ICARO-3 study.

    PubMed

    Paciaroni, Maurizio; Inzitari, Domenico; Agnelli, Giancarlo; Caso, Valeria; Balucani, Clotilde; Grotta, James C; Sarraj, Amrou; Sung-Il, Sohn; Chamorro, Angel; Urra, Xabier; Leys, Didier; Henon, Hilde; Cordonnier, Charlotte; Dequatre, Nelly; Aguettaz, Pierre; Alberti, Andrea; Venti, Michele; Acciarresi, Monica; D'Amore, Cataldo; Zini, Andrea; Vallone, Stefano; Dell'Acqua, Maria Luisa; Menetti, Federico; Nencini, Patrizia; Mangiafico, Salvatore; Barlinn, Kristian; Kepplinger, Jessica; Bodechtel, Ulf; Gerber, Johannes; Bovi, Paolo; Cappellari, Manuel; Linfante, Italo; Dabus, Guilherme; Marcheselli, Simona; Pezzini, Alessandro; Padovani, Alessandro; Alexandrov, Andrei V; Shahripour, Reza Bavarsad; Sessa, Maria; Giacalone, Giacomo; Silvestrelli, Giorgio; Lanari, Alessia; Ciccone, Alfonso; De Vito, Alessandro; Azzini, Cristiano; Saletti, Andrea; Fainardi, Enrico; Orlandi, Giovanni; Chiti, Alberto; Gialdini, Gino; Silvestrini, Mauro; Ferrarese, Carlo; Beretta, Simone; Tassi, Rossana; Martini, Giuseppe; Tsivgoulis, Georgios; Vasdekis, Spyros N; Consoli, Domenico; Baldi, Antonio; D'Anna, Sebastiano; Luda, Emilio; Varbella, Ferdinando; Galletti, Giampiero; Invernizzi, Paolo; Donati, Edoardo; De Lodovici, Maria Luisa; Bono, Giorgio; Corea, Francesco; Sette, Massimo Del; Monaco, Serena; Riva, Maurizio; Tassinari, Tiziana; Scoditti, Umberto; Toni, Danilo

    2015-02-01

    The aim of the ICARO-3 study was to evaluate whether intra-arterial treatment, compared to intravenous thrombolysis, increases the rate of favourable functional outcome at 3 months in acute ischemic stroke and extracranial ICA occlusion. ICARO-3 was a non-randomized therapeutic trial that performed a non-blind assessment of outcomes using retrospective data collected prospectively from 37 centres in 7 countries. Patients treated with endovascular treatment within 6 h from stroke onset (cases) were matched with patients treated with intravenous thrombolysis within 4.5 h from symptom onset (controls). Patients receiving either intravenous or endovascular therapy were included among the cases. The efficacy outcome was disability at 90 days assessed by the modified Rankin Scale (mRS), dichotomized as favourable (score of 0-2) or unfavourable (score of 3-6). Safety outcomes were death and any intracranial bleeding. Included in the analysis were 324 cases and 324 controls: 105 cases (32.4 %) had a favourable outcome as compared with 89 controls (27.4 %) [adjusted odds ratio (OR) 1.25, 95 % confidence interval (CI) 0.88-1.79, p = 0.1]. In the adjusted analysis, treatment with intra-arterial procedures was significantly associated with a reduction of mortality (OR 0.61, 95 % CI 0.40-0.93, p = 0.022). The rates of patients with severe disability or death (mRS 5-6) were similar in cases and controls (30.5 versus 32.4 %, p = 0.67). For the ordinal analysis, adjusted for age, sex, NIHSS, presence of diabetes mellitus and atrial fibrillation, the common odds ratio was 1.15 (95 % IC 0.86-1.54), p = 0.33. There were more cases of intracranial bleeding (37.0 versus 17.3 %, p = 0.0001) in the intra-arterial procedure group than in the intravenous group. After the exclusion of the 135 cases treated with the combination of I.V. thrombolysis and I.A. procedures, 67/189 of those treated with I.A. procedures (35.3 %) had a favourable outcome, compared to 89/324 of those treated with I.V. thrombolysis (27.4 %) (adjusted OR 1.75, 95 % CI 1.00-3.03, p = 0.05). Endovascular treatment of patients with acute ICA occlusion did not result in a better functional outcome than treatment with intravenous thrombolysis, but was associated with a higher rate of intracranial bleeding. Overall mortality was significantly reduced in patients treated with endovascular treatment but the rates of patients with severe disability or death were similar. When excluding all patients treated with the combination of I.V. thrombolysis and I.A. procedures, a potential benefit of I.A. treatment alone compared to I.V. thrombolysis was observed. PMID:25451851

  16. Intravenous nutrient therapy eliminated androgen deprivation therapy-induced hot flashes in two men with prostate cancer.

    PubMed

    Massey, Patrick

    2006-01-01

    Androgen deprivation therapy (ADT) is commonly used for the treatment of prostate cancer. For many undergoing ADT, hot flashes can affect and significantly reduce quality of life. Traditional medications for hot flashes are limited by both clinical effectiveness and side effects. In two case reports, ADT-induced hot flashes quickly resolved after a short course of a specific intravenous combination of vitamins and minerals. This therapeutic approach may have potential for the treatment of ADT-induced hot flashes. PMID:17022923

  17. Adjuvant TNF-? therapy to electrochemotherapy with intravenous cisplatin in murine sarcoma exerts synergistic antitumor effectiveness

    PubMed Central

    Cemazar, Maja; Todorovic, Vesna; Scancar, Janez; Lampreht, Ursa; Stimac, Monika; Kamensek, Urska; Kranjc, Simona; Coer, Andrej; Sersa, Gregor

    2015-01-01

    Background Electrochemotherapy is a tumour ablation modality, based on electroporation of the cell membrane, allowing non-permeant anticancer drugs to enter the cell, thus augmenting their cytotoxicity by orders of magnitude. In preclinical studies, bleomycin and cisplatin proved to be the most suitable for clinical use. Intravenous administration of cisplatin for electrochemotherapy is still not widely accepted in the clinics, presumably due to its lower antitumor effectiveness, but adjuvant therapy by immunomodulatory or vascular-targeting agents could provide a way for its potentiation. Hence, the aim of the present study was to explore the possibility of adjuvant tumour necrosis factor ? (TNF-?) therapy to potentiate antitumor effectiveness of electrochemotherapy with intravenous cisplatin administration in murine sarcoma. Materials and methods In vivo study was designed to evaluate the effect of TNF-? applied before or after the electrochemotherapy and to evaluate the effect of adjuvant TNF-? on electrochemotherapy with different cisplatin doses. Results A synergistic interaction between TNF-? and electrochemotherapy was observed. Administration of TNF-? before the electrochemotherapy resulted in longer tumour growth delay and increased tumour curability, and was significantly more effective than TNF-? administration after the electrochemotherapy. Tumour analysis revealed increased platinum content in tumours, TNF-? induced blood vessel damage and increased tumour necrosis after combination of TNF-? and electrochemotherapy, indicating an anti-vascular action of TNF-?. In addition, immunomodulatory effect might have contributed to curability rate of the tumours. Conclusion Adjuvant intratumoural TNF-? therapy synergistically contributes to electrochemotherapy with intravenous cisplatin administration. Due to its potentiation at all doses of cisplatin, the combined treatment is predicted to be effective also in tumours, where the drug concentration is suboptimal or in bigger tumours, where electrochemotherapy with intravenous cisplatin is not expected to be sufficiently effective. PMID:25810699

  18. CD8+ Treg Cells Associated with Decreasing Disease Activity after Intravenous Methylprednisolone Pulse Therapy in Lupus Nephritis with Heavy Proteinuria

    PubMed Central

    Lin, Tze-Yi; Lin, Ching-Yuang

    2014-01-01

    We focus on the role of CD8+ Treg cell in Intravenous methyl-prednisolone (IVMP) pulse therapy in forty patients with active Class III/IV childhood lupus nephritis (LN) with heavy proteinuria. IVMP therapy for five days. From peripheral blood mononuclear cells (PBMCs) and renal tissues, we saw IVMP therapy definitely restoring both CD4+CD25+FoxP3+ and CD8+CD25+Foxp3+ Treg cell number plus greater expression with intracellular IL-10 and granzyme B in CD8+FoxP3+ Treg from PBMCs. IVMP-treated CD8+CD25+ Treg cells directly suppressed CD4+ T proliferation and induced CD4+CD45RO+ apoptosis. Histologically, CD4+FoxP3+ as well as CD8+FoxP3+ Treg cells appeared in renal tissue of LN patients before IVMP by double immunohistochemical stain. CD8+FoxP3+ Treg cells increased in 10 follow-up renal biopsy specimens after IVMP. Reverse correlation of serum anti-C1q antibody and FoxP3+ Treg cells in PBMNCs (r?=??0.714, P<0.01). After IVMP, serum anti-C1q antibody decrease accompanied increase of CD4+FoxP3+ Treg cells. CD8+Treg cells reduced interferon-r response in PBMCs to major peptide autoepitopes from nucleosomes after IVMP therapy; siRNA of FoxP3 suppressed granzyme B expression while decreasing CD8+CD25+Treg-induced CD4+CD45RO+ apoptosis. Renal activity of LN by SLEDAI-2k in childhood LN was significantly higher than two weeks after IVMP (P<0.01). CD8+FoxP3+ Treg cells return in post-IVMP therapy and exert crucial immune modulatory effect to control autoimmune response in LN. Trial Registration DMR97-IRB-259 PMID:24475019

  19. Intravenous immunoglobulin replacement therapy to prevent pulmonary infection in a patient with Good's syndrome.

    PubMed

    Wang, Ching-Hsun; Chan, Edward D; Perng, Cherng-Lih; Chian, Chih-Feng; Chen, Chien-Wen; Perng, Wann-Cherng; Su, Wen-Lin

    2015-04-01

    Good's syndrome is an acquired immunodeficiency state associated with thymoma and characterized by recurrent pulmonary infections. We describe a 67-year-old woman who presented with respiratory symptoms caused by concomitant disseminated cytomegalovirus infection and Pneumocystis jiroveci pneumonia 38 months after thymectomy for a thymoma. Immunologic analysis revealed hypogammaglobulinemia with absent B-cell population as demonstrated by flow cytometry, consistent with Good's syndrome. Following treatment with sulfamethoxazole/trimethoprim and ganciclovir, the patient improved with resolution of her respiratory symptoms. However, the patient subsequently experienced additional infections, necessitating additional subsequent hospital admissions. During the last admission, intravenous immunoglobulin (IVIG) replacement therapy was initiated and continued after discharge. Infection has been prevented for one year after beginning IVIG replacement therapy. This case reveals that in patients with combined humoral and cell-mediated immune deficiency, concomitant infection with different pathogens is not unusual, and immediate specific therapy is important. Periodic IVIG infusion, to maintain adequate Ig levels, is recommended. PMID:23200552

  20. Management of acute heart failure and the effect of systolic blood pressure on the use of intravenous therapies

    PubMed Central

    Harjola, Veli-Pekka; Tolonen, Jukka; Siirilä-Waris, Krista; Nieminen, Markku S; Lassus, Johan

    2013-01-01

    Aims: To examine the use of the treatments for acute heart failure (AHF) recommended by ESC guidelines in different clinical presentations and blood pressure groups. Methods: The use of intravenous diuretics, nitrates, opioids, inotropes, and vasopressors as well as non-invasive ventilation (NIV) was analysed in 620 patients hospitalized due to AHF. The relation between AHF therapies and clinical presentation, especially systolic blood pressure (SBP) on admission, was also assessed. Results: Overall, 76% of patients received i.v. furosemide, 42% nitrates, 29% opioids, 5% inotropes and 7% vasopressors, and 24% of patients were treated with NIV. Furosemide was the most common treatment in all clinical classes and irrespective of SBP on admission. Nitrates were given most often in pulmonary oedema and hypertensive AHF. Overall, only SBP differed significantly between patients with and without the studied treatments. SBP was higher in patients treated with nitrates than in those who were not (156 vs. 141 mmHg, p<0.001). Still, only one-third of patients presenting acute decompensated heart failure and SBP over 120 mmHg were given nitrates. Inotropes and vasopressors were given most frequently in cardiogenic shock and pulmonary oedema, and their use was inversely related to initial SBP (p<0.001). NIV was used only in half of the cardiogenic shock and pulmonary oedema patients. Conclusions: The management of AHF differs between ESC clinical classes and the use of i.v. vasoactive therapies is related to the initial SBP. However, there seems to be room for improvement in administration of vasodilators and NIV. PMID:24222833

  1. Bilateral Atypical Femoral Fractures in a Patient with Multiple Myeloma Treated with Intravenous Bisphosphonate Therapy

    PubMed Central

    Iwame, Toshiyuki; Yoshioka, Shinji; Tsutsui, Takahiko; Goda, Yuichiro; Egawa, Hiroshi; Sairyo, Koichi

    2014-01-01

    Bisphosphonates are currently the standard approach to managing bone disease in multiple myeloma. Bisphosphonates have high bone affinity that inhibits osteoclastic activity and additionally reduces the growth factors released from malignant or osteoblastic cells, thereby impairing abnormal bone remodeling which leads to osteolysis. However, patients of multiple myeloma may be at a higher risk of atypical femoral fractures because the treatment for malignant myeloma requires notably higher cumulative doses of bisphosphonates. Here we present a patient with bilateral atypical femoral fractures and multiple myeloma treated with intravenous bisphosphonate therapy. PMID:25140264

  2. Perioperative intravenous iron: an upfront therapy for treating anaemia and reducing transfusion requirements.

    PubMed

    Muñoz, M; Gómez-Ramírez, S; Martín-Montañez, E; Pavía, J; Cuenca, J; García-Erce, J A

    2012-01-01

    Perioperative anaemia, with iron deficiency being its leading cause, is a frequent condition among surgical patients, and has been linked to increased postoperative morbidity and mortality, and decreased quality of life. Postoperative anaemia is even more frequent and is mainly caused by perioperative blood loss, aggravated by inflammation-induced blunting of erythropoiesis. Allogenic transfusion is commonly used for treating acute perioperative anaemia, but it also increases the rate of morbidity and mortality in surgical and critically ill patients. Thus, overall concerns about adverse effects of both preoperative anaemia and allogeneic transfusion have prompted the review of transfusion practice and the search for safer and more biologically rational treatment options. In this paper, the role of intravenous iron therapy (mostly with iron sucrose and ferric carboxymaltose), as a safe and efficacious tool for treating anaemia and reducing transfusion requirements in surgical patients, as well as in other medical areas, has been reviewed. From the analysis of published data and despite the lack of high quality evidence in some areas, it seems fair to conclude that perioperative intravenous iron administration, with or without erythropoiesis stimulating agents, is safe, results in lower transfusion requirements and hastens recovery from postoperative anaemia. In addition, some studies have reported decreased rates of postoperative infection and mortality, and shorter length of hospital stay in surgical patients receiving intravenous iron. PMID:23588429

  3. Naloxone therapy in opioid overdose patients: intranasal or intravenous? A randomized clinical trial

    PubMed Central

    Sabzghabaee, Ali Mohammad; Eizadi-Mood, Nastaran; Zandifar, Samaneh

    2014-01-01

    Introduction This study was designed to compare the effects of intranasal (IN) and intravenous (IV) administration of naloxone in patients who had overdosed on opioids. Material and methods This randomized clinical trial study was conducted in the Department of Poisoning Emergencies at Noor and Ali Asghar (PBUH) University Hospital. One hundred opioid overdose patients were assigned by random allocation software into two study groups (n = 50). Both groups received 0.4 mg naloxone: one group IN and the other IV. Outcomes included change in the level of consciousness (measured using a descriptive scale and the Glasgow Coma Scale (GCS)), time to response, vital signs (blood pressure, heart rate and respiratory rate), arterial blood O2 saturation before and after naloxone administration, side-effects (agitation) and length of hospital stay. Results Patients who had been administered IN naloxone demonstrated significantly higher levels of consciousness than those in the IV group using both descriptive and GCS scales (p < 0.001). There was a significant difference in the heart rate between IN and IV groups (p = 0.003). However, blood pressure, respiratory rate and arterial O2 saturation were not significantly different between the two groups after naloxone administration (p = 0.18, p = 0.17, p = 0.32). There was also no significant difference in the length of hospital stay between the two groups (p = 0.14). Conclusions Intranasal naloxone is as effective as IV naloxone in reversing both respiratory depression and depressive effects on the central nervous system caused by opioid overdose. PMID:24904666

  4. Imaging-based treatment selection for intravenous and intra-arterial stroke therapies: a comprehensive review

    PubMed Central

    Yoo, Albert J; Pulli, Benjamin; Gonzalez, R Gilberto

    2011-01-01

    Reperfusion therapy is the only approved treatment for acute ischemic stroke. The current approach to patient selection is primarily based on the time from stroke symptom onset. However, this algorithm sharply restricts the eligible patient population, and neglects large variations in collateral circulation that ultimately determine the therapeutic time window in individual patients. Time alone is unlikely to remain the dominant parameter. Alternative approaches to patient selection involve advanced neuroimaging methods including MRI diffusion-weighted imaging, magnetic resonance and computed tomography perfusion imaging and noninvasive angiography that provide potentially valuable information regarding the state of the brain parenchyma and the neurovasculature. These techniques have now been used extensively, and there is emerging evidence on how specific imaging data may result in improved clinical outcomes. This article will review the major studies that have investigated the role of imaging in patient selection for both intravenous and intra-arterial therapies. PMID:21809968

  5. Risk of bacterial infection in patients under intravenous iron therapy: dose versus length of treatment.

    PubMed

    Canziani, M E; Yumiya, S T; Rangel, E B; Manfredi, S R; Neto, M C; Draibe, S A

    2001-11-01

    Some studies have suggested that intravenous iron therapy may be associated with an increased risk of infection. We analyzed the incidence of bacterial infection in 111 hemodialysis patients. Group 1 (n = 39, transferrin saturation <20%) received 10 doses of 100 mg of intravenous iron saccharate, 3 doses per week (28 treatment days); Group 2 (n = 13, transferrin saturation <20%) received 20 doses, 3 doses per week (70 treatment days); and Group 3 (n = 59, transferrin saturation 20-50%) received 10 doses, 1 dose per week (70 treatment days). The follow-up was 150 days for all groups, and all infectious episodes were recorded. Pulmonary infection was the most frequent event observed in all of the groups. In an incidence-density analysis, Group 2, which received a total of 20 doses, presented a significantly higher incidence of infection than Group 3, which received only 10 doses over the same period (0.13 versus 0.06 infections per patient per month, p = 0.04). No difference was observed between Groups 1 and 2 suggesting that the risk of infection during iron therapy is dose dependent rather than time length dependent. PMID:11903138

  6. Intravenous Therapy Duration and Outcomes in Melioidosis: A New Treatment Paradigm

    PubMed Central

    Pitman, Matthew C.; Luck, Tara; Marshall, Catherine S.; Anstey, Nicholas M.; Ward, Linda; Currie, Bart J.

    2015-01-01

    Background International melioidosis treatment guidelines recommend a minimum 10 to 14 days’ intravenous antibiotic therapy (intensive phase), followed by 3 to 6 months’ oral therapy (eradication phase). This approach is associated with rates of relapse, defined as recurrence following the eradication phase, that can exceed 5%. Rates of recrudescence, defined as recurrence during the eradication phase, have not previously been reported. In response to low eradication phase completion rates in Australia, a local guideline has evolved over the last ten years recommending a longer minimum intensive phase duration for many cases of melioidosis. Methodology/ Principal Findings This retrospective cohort study reviews antibiotic duration for the first episode of care for all patients diagnosed with melioidosis and surviving the intensive phase during a recent three year period in the tropical north of Australia’s Northern Territory; we also review adherence to the current local guideline and treatment outcomes. Of 215 first episodes of melioidosis surviving the intensive phase, the median (interquartile range) intensive phase duration was 26 (14-34) days. One hundred and eight (50.2%) patients completed eradication therapy; 58 (27.0%) patients took no eradication therapy. At 28 months’ follow-up, one (0.5%) relapse and eleven (5.1%) recrudescences had occurred. On exact logistic regression analysis, the only independent risk factors for recrudescence were self-discharge during the intensive phase (odds ratio 6.2 [95% confidence interval 1.2-30.0]) and septic shock (odds ratio 5.3 [95% confidence interval 1.1-25.7]). Conclusions/ Significance Relapsed melioidosis is rare in patients who receive a minimum intensive phase duration specified by our guideline and extended according to clinical progress. Recrudescence rates may improve with reductions in rates of self-discharge. Given the low relapse rate despite a high rate of eradication therapy non-adherence, the duration and necessity of eradication therapy for different patients after guideline-concordant intensive therapy should be evaluated further. PMID:25811783

  7. Iron therapy for the treatment of iron deficiency in chronic heart failure: intravenous or oral?

    PubMed

    McDonagh, Theresa; Macdougall, Iain C

    2015-03-01

    This article considers the use and modality of iron therapy to treat iron deficiency in patients with heart failure, an aspect of care which has received relatively little attention compared with the wider topic of anaemia management. Iron deficiency affects up to 50% of heart failure patients, and is associated with poor quality of life, impaired exercise tolerance, and mortality independent of haematopoietic effects in this patient population. The European Society of Cardiology Guidelines for heart failure 2012 recommend a diagnostic work-up for iron deficiency in patients with suspected heart failure. Iron absorption from oral iron preparations is generally poor, with slow and often inefficient iron repletion; moreover, up to 60% of patients experience gastrointestinal side effects. These problems may be exacerbated in heart failure due to decreased gastrointestinal absorption and poor compliance due to pill burden. Evidence for clinical benefits using oral iron is lacking. I.v. iron sucrose has consistently been shown to improve exercise capacity, cardiac function, symptom severity, and quality of life. Similar findings were observed recently for i.v. ferric carboxymaltose in patients with systolic heart failure and impaired LVEF in the double-blind, placebo-controlled FAIR-HF and CONFIRM-HF trials. I.v. iron therapy may be better tolerated than oral iron, although confirmation in longer clinical trials is awaited. Routine diagnosis and management of iron deficiency in patients with symptomatic heart failure regardless of anaemia status is advisable, and, based on current evidence, prompt intervention using i.v. iron therapy should now be considered. PMID:25639592

  8. Iron Deficiency Anaemia in Pregnancy and Postpartum: Pathophysiology and Effect of Oral versus Intravenous Iron Therapy

    PubMed Central

    Khalafallah, Alhossain A.; Dennis, Amanda E.

    2012-01-01

    Nutritional iron-deficiency anaemia (IDA) is the most common disorder in the world, affecting more than two billion people. The World Health Organization's global database on anaemia has estimated a prevalence of 14% based on a regression-based analysis. Recent data show that the prevalence of IDA in pregnant women in industrialized countries is 17.4% while the incidence of IDA in developing countries increases significantly up to 56%. Although oral iron supplementation is widely used for the treatment of IDA, not all patients respond adequately to oral iron therapy. This is due to several factors including the side effects of oral iron which lead to poor compliance and lack of efficacy. The side effects, predominantly gastrointestinal discomfort, occur in a large cohort of patients taking oral iron preparations. Previously, the use of intravenous iron had been associated with undesirable and sometimes serious side effects and therefore was underutilised. However, in recent years, new type II and III iron complexes have been developed, which offer better compliance and toleration as well as high efficacy with a good safety profile. In summary, intravenous iron can be used safely for a rapid repletion of iron stores and correction of anaemia during and after pregnancy. PMID:22792466

  9. Extensive hidradenitis suppurativa (HS) Hurly stage III disease treated with intravenous (IV) linezolid and meropenem with rapid remission.

    PubMed

    Scheinfeld, Noah

    2015-01-01

    A 57-year-old woman with Hurley Stage 3 hidradenitis suppurativa (HS) and multiple co-morbidities is presented. She had failed multiple antibiotic therapies and etanercept. She had end stage renal disease and was on dialysis. Her HS was put into remission with one month of daily IV treatment with 1.2 grams linezolid and 1 gram of meropenem, administered daily through her dialysis shunt. Unfortunately, her disease flared again two weeks after the cessation of the IV treatment. Nevertheless, more conventional therapy was then able to maintain her disease at a level that was significantly improved over baseline prior to the IV treatment. This case highlights above all a primary etiology of HS is stimulus of immune system's over-reaction in HS to the bacterial microbiome. If antibiotics are administered to a patient with stage 3 HS powerful enough to wipe out the bacterial biome, the immune system having no target retreats, permanent scarring in its wake and retreats to a certain but hardly permanent normalcy. PMID:25756493

  10. Bortezomib-based induction therapy followed by intravenous busulfan-melphalan as conditioning regimen for patients with newly diagnosed multiple myeloma.

    PubMed

    Blanes, Margarita; González, José D; Lahuerta, Juan J; Ribas, Paz; Lorenzo, Ignacio; Boluda, Blanca; Sanz, Miguel A; de la Rubia, Javier

    2015-02-01

    Abstract A bortezomib-containing regimen followed by high-dose therapy and autologous stem cell transplant (ASCT) is considered the standard of care for front-line therapy in younger patients with newly diagnosed multiple myeloma (MM). We analyzed the results of ASCT with an intravenous busulfan 9.6 mg/kg and melphalan 140 mg/m(2) (ivBUMEL) preparative regimen in 47 patients with newly diagnosed MM who had received bortezomib-based combinations as pre-transplant induction. The overall response rate and complete response after transplant were 100% and 49%, respectively. With a median follow-up of 24.5 months, median overall survival and progression-free survival have not been reached. Mucositis and febrile neutropenia were the most frequent toxicities observed. No case of sinusoidal obstruction syndrome was observed and there was no transplant-related mortality. These results suggest that front-line induction therapy with a bortezomib-based combination followed by ASCT with ivBUMEL is an effective and well-tolerated therapeutic approach for transplant eligible patients with MM. PMID:24828869

  11. Effects of increasing doses of a bolus injection and an intravenous long-term therapy of taurolidine on subcutaneous (metastatic) tumor growth in rats

    Microsoft Academic Search

    Chris Braumann; Marco Schoenbeck; Charalambos Menenakos; Maik Kilian; Christoph A. Jacobi

    2005-01-01

    Background experimental studies have shown that taurolidine suppresses intraperitoneal tumor growth following local application in rats. In opposite, a single intravenous therapy affected neither intraperitoneal nor subcutaneous growth of malignancies. Thus, an intravenous long-term therapy with taurolidine was investigated in rats after administration of a subcutaneous tumor load. VEGF and TNF? production and their effects on tumor growth have not

  12. Efficacy of high-dose intravenous immunoglobulin therapy in Japanese patients with steroid-resistant polymyositis and dermatomyositis

    Microsoft Academic Search

    Eizo Saito; Takao Koike; Hiroshi Hashimoto; Nobuyuki Miyasaka; Yasuo Ikeda; Masako Hara; Hidehiro Yamada; Tadashi Yoshida; Masayoshi Harigai; Yoichi Ichikawa

    2008-01-01

    Intravenous immunoglobulin (IVIG) therapy was administered to 15 patients who were refractory to traditional steroid therapy\\u000a [eight with polymyosis (PM), seven with dermamyosis (DM)] to evaluate its efficacy. Serum creatine kinase (CK) significantly\\u000a decreased from week 1, and manual muscle test scores (MMT) and activities of daily living (ADL) significantly increased from\\u000a week 2. Efficacy rates were 93.3% (14\\/15 patients)

  13. Changes in serum macrophage-related factors in patients with chronic inflammatory demyelinating polyneuropathy caused by intravenous immunoglobulin therapy

    Microsoft Academic Search

    Kazuhide Ochi; Tatsuo Kohriyama; Masahiro Higaki; Junko Ikeda; Akira Harada; Shigenobu Nakamura

    2003-01-01

    Chronic inflammatory demyelinating polyneuropathy (CIDP) is a slowly progressive or recurrent neuropathy accompanied by infiltration of macrophages in the peripheral nerves. Macrophage colony-stimulating factor (M-CSF) and monocyte chemoattractant protein-1 (MCP-1) are a macrophage-related cytokine and chemokine, respectively. Although, intravenous immunoglobulin (IVIg) infusion therapy has been used for treating CIDP patients, not all CIDP patients have responded to IVIg infusion therapy.

  14. Intravenous Fluid Use in Athletes

    PubMed Central

    Givan, Gordon V.; Diehl, Jason J.

    2012-01-01

    Context: Time allowing, euhydration can be achieved in the vast majority of individuals by drinking and eating normal beverages and meals. Important to the competitive athlete is prevention and treatment of dehydration and exercise-associated muscle cramps, as they are linked to a decline in athletic performance. Intravenous (IV) prehydration and rehydration has been proposed as an ergogenic aid to achieve euhydration more effectively and efficiently. Evidence Acquisition: PubMed database was searched in November 2011 for all English-language articles related to IV utilization in sport using the keywords intravenous, fluid requirements, rehydration, hydration, athlete, sport, exercise, volume expansion, and performance. Results: Limited evidence exists for prehydration with IV fluids. Although anecdotal evidence does exist, at this time there are no high-level studies confirming that IV prehydration prevents dehydration or the onset of exercise-associated muscle cramps. Currently, there are no published studies describing IV fluid use during the course of an event, at intermission, or after the event as an ergogenic aid. Conclusion: The use of IV fluid may be beneficial for a subset of fluid-sensitive athletes; this should be reserved for high-level athletes with strong histories of symptoms in well-monitored settings. Volume expanders may also be beneficial for some athletes. IV fluids and plasma binders are not allowed in World Anti-Doping Agency–governed competitions. Routine IV therapy cannot be recommended as best practice for the majority of athletes. PMID:23016105

  15. [Studies on the metabolic fate of isepamicin sulfate (HAPA-B). IV. Intramuscular, intravenous and drip intravenous administration of HAPA-B in dogs].

    PubMed

    Serizawa, K; Shirai, M; Endo, S; Suzuki, T; Morishita, M

    1987-01-01

    The plasma concentration and urinary excretion of isepamicin sulfate (HAPA-B) were studied following intramuscular, intravenous and drip intravenous administrations of 6.25, 25 and 100 mg/kg in dogs. Maximum plasma concentrations (Cmax) of HAPA-B after intramuscular, intravenous and drip intravenous administration depended on dosage levels. Biological half-lives (T1/2) and areas under plasma concentration-time curves (AUC) for the three different routes of administration were similar to each other. The peak plasma concentration of HAPA-B achieved with intramuscular administration was similar to that with a 1-hour drip intravenous administration at a dose level of 6.25 or 25 mg/kg. On the other hand, at a dose level of 100 mg/kg, the Cmax following intramuscular administration was similar to that following 2-hour drip intravenous administration. It was, therefore, presumed that the plasma concentration curves which are similar to that of intramuscular administration can be obtained by regulating the infusion time. The observed Cmax value for drip intravenous administration was a little higher than the theoretical Cmax value for drip intravenous administration calculated from parameters for intramuscular administration. Simulation curves obtained for extended infusion times agreed more closely with observed curves than curves simulated for shorter infusion periods. These investigations showed that plasma concentration curves for any dosage levels can be estimated from parameters calculated from experimental data obtained using intramuscular or drip intravenous administration. HAPA-B was rapidly excreted into the urine after administration through any of these 3 routes and 71 approximately 89% of the dose was excreted into the unrine in 24 hours at all dosage levels. Bioautograms of thin-layer chromatographs of the 0 approximately 6 hours urine after intramuscular administration showed single bands with a similar Rf value to that of the standard HAPA-B. No significant differences in plasma concentration and urinary excretion between HAPA-B and amikacin were observed upon intramuscular or intravenous administration of 25 mg/kg. PMID:3586331

  16. Does low-level laser therapy enhance the efficacy of intravenous regional anesthesia?

    PubMed Central

    Nesioonpour, Sholeh; Akhondzadeh, Reza; Mokmeli, Soheila; Moosavi, Shahnam; Mackie, Mandana; Naderan, Morteza

    2014-01-01

    BACKGROUND: The use of intravenous regional anesthesia (IVRA) is limited by pain resulting from the application of tourniquets and postoperative pain. OBJECTIVE: To assess the efficacy of low-level laser therapy added to IVRA for improving pain related to surgical fixation of distal radius fractures. METHODS: The present double-blinded, placebo-controlled, randomized clinical trial involved 48 patients who were undergoing surgical fixation of distal radius fractures. Participants were randomly assigned to either an intervention group (n=24), who received 808 nm laser irradiation as 4 J/point for 20 s over ipsilateral three nerve roots in the cervical region corresponding to C5–C8 vertebrae, and 808 nm laser irradiation as 0.1 J/cm2 for 5 min in a tangential scanning mode over the affected extremity; or a control group (n=24), who underwent the same protocol and timing of laser probe application with the laser switched off. Both groups received the same IVRA protocol using 2% lidocaine. RESULTS: The mean visual analogue scale scores were significantly lower in the laser-assisted group than in the lidocaine-only group on all measurements during and after operation (P<0.05). The mean time to the first need for fentanyl administration during the operation was longer in the laser group (P=0.04). The total amount of fentanyl administered to patients was significantly lower in the laser-assisted group (P=0.003). The laser group needed significantly less pethidine for pain relief (P=0.001) and at a later time (P=0.002) compared with the lidocaine-only group. There was no difference between the groups in terms of mean arterial pressure and heart rate. CONCLUSION: The addition of gallium-aluminum-arsenide laser irradiation to intravenous regional anesthesia is safe, and reduces pain during and after the operation. PMID:24945286

  17. Pharmacodynamics of intravenous labetalol and follow-up therapy with oral labetalol.

    PubMed

    Vlachakis, N D; Maronde, R F; Maloy, J W; Medakovic, M; Kassem, N

    1985-11-01

    The effectiveness, safety, and pharmacodynamics of repeated doses of intravenous labetalol for rapid reduction of severe hypertension and of subsequent oral labetalol dosing were studied. Twelve patients with severe hypertension were admitted to the hospital after the withholding of antihypertensive therapy for 2 to 14 days. Thirty minutes after an injection of vehicle only, labetalol, 0.25 mg/kg body weight, was injected and followed by repeat injections of 0.5 mg/kg every 15 minutes until the supine diastolic blood pressure (BP) was reduced to less than 90 mm Hg or a total of 3.25 mg/kg had been administered. Twenty-four hours after the last injection, oral labetalol was started at an initial dosage of 100 or 200 mg b.i.d., then increased every 2 days until the standing diastolic BP was less than 90 mm Hg or a maximum daily dosage of 2400 mg was reached. The initial injection achieved mean falls in supine systolic/diastolic BPs of 11/7 mm Hg. Subsequent injections produced additional falls in a dose-related fashion; the mean falls after the last injection (total cumulative dose 2.7 mg/kg) were 40/20 mm Hg. The effect lasted for 12 hours or more in most patients and tended to be biphasic, with one peak at approximately 5 minutes and another much less pronounced peak at about 4 hours. There was no evidence of precipitous falls in BP. All patients were able to ambulate 6 hours after the last injection without symptoms of postural hypotension. Oral labetalol effectively and safely restored and maintained the BP reductions achieved with intravenous labetalol. PMID:4053487

  18. Response of HIV-infected patients with syphilis to therapy with penicillin or intravenous ceftriaxone

    PubMed Central

    2011-01-01

    Background Ceftriaxone is commonly used as an alternative antibiotic drug in treating syphilis but clinical data on its efficacy are limited. Objective: To evaluate the response of HIV-infected patients with active syphilis to treatment with penicillin or ceftriaxone. Methods A retrospective study involving 24 consecutive patients with a positive Veneral Disease Research Laboratory test (VDRL) and at least one specific treponemal test. 12 patients were treated with different regimens of high-dose penicillin G for at least 2 weeks. Another 12 patients were treated with ceftriaxone 1-2 g per day intravenously for 10-21 days. Results After a median follow up of 18,3 months all patients of the penicillin-treated group and 11 of 12 ceftriaxone-treated patients showed a ? 4-fold decline in VDRL-titers; 91% of them already within 6 months after therapy. Conclusion Our serological data demonstrate a comparable efficacy of currently recommened penicillin and ceftriaxone treatment regimens for active syphilis in HIV-infected patients. PMID:21463980

  19. Practical guidelines for developing an office-based program for outpatient intravenous therapy.

    PubMed

    Green, S L

    1991-01-01

    As early discharge from the hospital and initiation of outpatient iv therapy have become more common, physicians have found that although their role as care giver has not diminished, compensation by insurers for that care has. Therefore, physicians may wish to establish their own office-based programs for providing cost-effective, quality care for patients who can be treated on an outpatient basis. Important factors in the establishment of such a program are obtaining the services of a nurse skilled in administration of iv antibiotics and the services of a cooperative pharmacist, utilizing treatment consent forms and instructive handouts for patients, and providing 7-day-per-week nursing care. Physicians must immediately hospitalize program participants who experience complications. To ensure cooperation from third-party payers, familiarity with their codes for procedural terminology is necessary. It is also highly advisable to obtain written approval for a patient's participation in the program from the medical director or another key official of the insurance company. PMID:2017650

  20. Intravenous saline has no effect on blood ethanol clearance

    Microsoft Academic Search

    James Li; Trevor Mills; Ray Erato

    1999-01-01

    For patients presenting to emergency departments with ethanol intoxication, intravenous (i.v.) fluids are initiated for varied reasons. This investigation determined the effect of i.v. fluid therapy on the rate of blood ethanol clearance in such patients. Volunteers received a predetermined dose of ethanol on two separate occasions. On the second occasion, volunteers rapidly received a liter of i.v. saline directly

  1. [Anti TNF-? (infliximab) treatment for intravenous immunoglobulin (IVIG) resistance patients with acute Kawasaki disease the effects of anticytokine therapy].

    PubMed

    Saji, Tsutomu; Takatsuki, Shinichi; Kobayashi, Toru

    2014-09-01

    Among the patients with acute Kawasaki disease treated with intravenous immunoglobulin (IVIG), 10-20 % demonstrate resistance or incomplete effects. Cardiac complication such as the coronary arterial aneurysm is frequent in these patients. For patients with IVIG-resistance, we have surveyed the efficacy and safety of anti-cytokine therapy with use of infliximab (Remicade), chimera type anti TNF-? agent, for children. After May, 2005, Remicade has been used in >500 pediatric patients in whom IVIG and intravenous methylprednisolone pulse therapy did not show significant effects. The efficacy and safety of Remicade on patients with IVIG-resistant Kawasaki disease has been observed but 10~20 % of patients was Remicade-resistant. Re-treatment with IVIG or steroids was also effective. The efficacy of Remicade for reducing the fever duration, CRP, WBC counts was promising, but reduction of the incidence of coronary aneurysm was not confirmed. Randomized clinical trial will be needed. PMID:25518416

  2. Treatment of Anemia in Heart Failure: Potential Risks and Benefits of Intravenous Iron Therapy in Cardiovascular Disease

    PubMed Central

    Jelani, Qurat-ul-ain; Katz, Stuart D.

    2010-01-01

    Iron-deficiency anemia is common is patients with heart failure (HF), but the optimum diagnostic tests to detect iron deficiency and the treatment options to replete iron have not been fully characterized. Recent studies in patients with HF indicate that intravenous iron can rapidly replenish iron stores in patients having iron-deficiency anemia, with resultant increased hemoglobin levels and improved functional capacity. Preliminary data from a sub-group analysis also suggests that supplemental intravenous iron therapy can improve functional capacity even in those subjects without anemia. The mechanisms responsible for this observation are not fully characterized, but may be related to beneficial effects of iron supplementation on mitochondrial respiration in skeletal muscle. The long-term safety of using intravenous iron supplementation in HF populations is not known. Iron is a known pro-oxidant factor that can inhibit nitric oxide signaling and irreversibly injury cells. Increased iron stores are associated with vascular endothelial dysfunction and increased risk of coronary heart disease events. Additional clinical trials are needed to more fully characterize the therapeutic potential and safety of intravenous iron in HF patients. PMID:20699672

  3. Intravenous Micronutrient Therapy (Myers' Cocktail) for Fibromyalgia: A Placebo-Controlled Pilot Study

    PubMed Central

    Ali, Ather; Njike, Valentine Yanchou; Northrup, Veronika; Sabina, Alyse B.; Williams, Anna-Leila; Liberti, Lauren S.; Perlman, Adam I.; Adelson, Harry

    2009-01-01

    Abstract Objectives Intravenous micronutrient therapy (IVMT), and specifically the Myers' Cocktail, is a popular approach for treating fibromyalgia syndrome (FMS) among complementary and alternative medicine practitioners, but its efficacy is uncertain. This trial assessed the feasibility, safety, and provided insights into the efficacy of this therapy. Design This was a randomized, double-blind, placebo-controlled pilot study. Locations The study locations were an academic research center, teaching hospital, and affiliated Integrative Medicine Center in Derby, CT. Subjects The subjects were 34 adults with American College of Rheumatology (ACR)-defined FMS. Intervention Subjects were randomly assigned either to treatment (weekly infusions of IVMT) or to placebo (weekly infusions of lactated Ringer's solution) for 8 weeks. Outcome measures Primary outcome was change in the Tender Point Index, assessed 8 and 12 weeks after initiation. Secondary measures included a Visual Analog Scale to assess global pain, and validated measures of physical function (Fibromyalgia Impact Questionnaire), mood (Beck Depression Index), and quality of life (Health Status Questionnaire 2.0). Results Clinically significant improvements were noted (of a magnitude similar to other effective interventions). However, in part because of the high placebo response and the small sample size, no statistically significant differences were seen between groups, in any outcome measure, at 8 and 16 weeks. Statistically significant within-group differences were seen in both the intervention and placebo groups, demonstrating a treatment effect for both IVMT and placebo. At 8 weeks, the IVMT group experienced significantly improved tender points, pain, depression, and quality of life directly following treatment (all p???0.02), while the placebo group experienced significantly improved tender points only (p???0.05). The treatment effects of IVMT persisted at 4 weeks postintervention for tender points, pain, and quality of life, while placebo effects persisted only for tender points. A single minor adverse event was noted in one subject in the intervention group. Conclusions This first controlled pilot study established the safety and feasibility of treating FMS with IVMT. Most subjects experienced relief as compared to baseline, but no statistically significant differences were seen between IVMT and placebo. The efficacy of IVMT for fibromyalgia, relative to placebo, is as yet uncertain. PMID:19250003

  4. Vibrio vulnificus infection in a hemodialysis patient receiving intravenous iron therapy.

    PubMed

    Barton, James C; Coghlan, Michael E; Reymann, Michael T; Ozbirn, Thomas W; Acton, Ronald T

    2003-09-01

    A 73-year-old man treated with long-term hemodialysis, erythropoietin, and intravenous iron sucrose infusions developed Vibrio vulnificus infection after eating raw oysters harvested from the Alabama coast. Five of the 31 persons with cases of V. vulnificus infection reported to the Alabama Department of Public Health (Montgomery) during 1996-2002 (including the patient described here) also had renal disease. Persons with renal disease, especially those treated with long-term hemodialysis and intravenous iron infusions, may have an increased risk of infection with V. vulnificus. PMID:12942420

  5. Oral rehydration versus intravenous therapy for treating dehydration due to gastroenteritis in children: a meta-analysis of randomised controlled trials

    Microsoft Academic Search

    Steven Bellemare; Lisa Hartling; Natasha Wiebe; Kelly Russell; William R Craig; Don McConnell; Terry P Klassen

    2004-01-01

    BACKGROUND: Despite treatment recommendations from various organizations, oral rehydration therapy (ORT) continues to be underused, particularly by physicians in high-income countries. We conducted a systematic review of randomised controlled trials (RCTs) to compare ORT and intravenous therapy (IVT) for the treatment of dehydration secondary to acute gastroenteritis in children. METHODS: RCTs were identified through MEDLINE, EMBASE, CENTRAL, authors and references

  6. Using Innovative Technologies to Set New Safety Standards for the Infusion of Intravenous Medications

    Microsoft Academic Search

    James A. Eskew; Judith Jacobi

    Intravenous (IV) administration errors present a particularly chal- lenging problem to hospital pharmacists. Current control systems intercept only 2% of drug administration errors causing preventable adverse drug events (PADEs). 4 Estimated costs per preventable ADE are $4685 (1993 dollars). Of the most serious, life-threatening errors, 60% are associated with IV therapy. Conventional, general-purpose infusion devices cannot limit doses or easily

  7. Salvage therapy with high dose Intravenous Immunoglobulins in acquired Von Willebrand Syndrome and unresponsive severe intestinal bleeding

    PubMed Central

    2014-01-01

    A 91-year-old woman affected with acquired Von Willebrand (VW) syndrome and intestinal angiodysplasias presented with severe gastrointestinal bleeding (hemoglobin 5 g/dl). Despite replacement therapy with VW factor/factor VIII concentrate qid, bleeding did not stop (eleven packed red blood cell units were transfused over three days). High circulating levels of anti-VW factor immunoglobulin M were documented immunoenzimatically. Heart ultrasound showed abnormalities of the mitral and aortic valves with severe flow alterations. When intravenous immunoglobulins were added to therapy, prompt clinical and laboratory responses occurred: complete cessation of bleeding, raise in hemoglobin, VW factor antigen, VW ristocetin cofactor and factor VIII levels as well as progressive reduction of the anti-VWF autoantibody levels. PMID:24926417

  8. IS DTPA A GOOD COMPETING CHELATING AGENT FOR Th(IV) IN HUMAN SERUM AND SUITABLE IN TARGETED ALPHA THERAPY ?

    E-print Network

    Paris-Sud XI, Université de

    serum transferrin (HSTf) interacts strongly with Th(IV), forming a ternary complex including two for application in targeted alpha therapy. KEYWORDS thorium; targeted alpha therapy, speciation, transferrin, DTPA(IV) was the iron-binding site of transferrin (HSTf). Similar behaviour was reported for different actinides (IV

  9. Effects of anti-inflammatory drugs on intravenous immunoglobulin therapy in the acute phase of Kawasaki disease.

    PubMed

    Nakada, Toshimasa

    2015-02-01

    This retrospective study aimed to investigate the effects of anti-inflammatory drugs (ADs) on intravenous immunoglobulin (IVIG) therapy in the acute phase of Kawasaki disease. In total, 182 pediatric patients who received IVIG therapy for Kawasaki disease between 1999 and 2013 at the Department of Pediatrics, Aomori Prefectural Central Hospital were enrolled. Patients were divided into 2 groups: an S group, including 111 patients who received single IVIG therapy with delayed administration of ADs, and a T group, including 71 patients who received concomitant AIDs with IVIG. During the study, the only ADs administered were aspirin (A: 30 mg/kg/day) or flurbiprofen (F: 3-5 mg/kg/day). Steroids were not administered to any patient. The regimen of the S group was partially used after 2004 and was used to all patients after 2009. The following clinical findings were significantly different between the S and T groups: disease onset before 2003 (0 vs. 59%, P < 0.001) and after 2009 (70 vs. 0%, P < 0.001), use of 2-g/kg/day IVIG therapy (100 vs. 93%, P = 0.034), ADs type (A/F: 62/49 vs. 17/54, P < 0.001), and the prevalence of coronary artery lesions (CAL) up to (1/111 vs. 11/71, P < 0.001) and after 30 days of illness (0/111 vs. 4/71, P = 0.022). Logistic regression analysis revealed that IVIG therapy only (S group; P = 0.009) and 2-g/kg/day IVIG therapy (P = 0.015) were significant factors for CAL suppression. The findings revealed a possible negative impact of ADs on initial IVIG therapy in the acute phase of Kawasaki disease. Initial single IVIG therapy with delayed administration of ADs may be useful to suppress CAL caused by Kawasaki disease. PMID:25158631

  10. Intratumoral gene therapy versus intravenous gene therapy for distant metastasis control with 2-diethylaminoethyl-dextran methyl methacrylate copolymer non-viral vector-p53.

    PubMed

    Baliaka, A; Zarogoulidis, P; Domvri, K; Hohenforst-Schmidt, W; Sakkas, A; Huang, H; Le Pivert, P; Koliakos, G; Koliakou, E; Kouzi-Koliakos, K; Tsakiridis, K; Chioti, A; Siotou, E; Cheva, A; Zarogoulidis, K; Sakkas, L

    2014-02-01

    Lung cancer still remains to be challenged by novel treatment modalities. Novel locally targeted routes of administration are a methodology to enhance treatment and reduce side effects. Intratumoral gene therapy is a method for local treatment and could be used either in early-stage lung cancer before surgery or at advanced stages as palliative care. Novel non-viral vectors are also in demand for efficient gene transfection to target local cancer tissue and at the same time protect the normal tissue. In the current study, C57BL/6 mice were divided into three groups: (a) control, (b) intravenous and (c) intatumoral gene therapy. The novel 2-Diethylaminoethyl-Dextran Methyl Methacrylate Copolymer Non-Viral Vector (Ryujyu Science Corporation) was conjugated with plasmid pSicop53 from the company Addgene for the first time. The aim of the study was to evaluate the safety and efficacy of targeted gene therapy in a Lewis lung cancer model. Indeed, although the pharmacokinetics of the different administration modalities differs, the intratumoral administration presented increased survival and decreased distant metastasis. Intratumoral gene therapy could be considered as an efficient local therapy for lung cancer. PMID:24285215

  11. Effect of aggressively driven intravenous iron therapy on infectious complications in end-stage renal disease patients on maintenance hemodialysis.

    PubMed

    Bansal, Anip; Sandhu, Gagangeet; Gupta, Isha; Kalahalli, Shriharsha; Nayak, Rushi; Zouain, Eduardo; Chitale, Rohit A; Meisels, Ira; Chan, Germaine

    2014-01-01

    For treating end-stage renal disease-associated anemia, various strategies to achieve optimal hemoglobin levels with lower erythropoiesis stimulating agent doses are being tried. One of these involves the use of a high dose [transferrin saturation (TSAT) >30%] of intravenous (IV) iron supplementation. However, due to in vitro effects of iron on stimulating bacterial growth, there are concerns of increased risk of infection. The safety of higher iron targets with respect to infectious complications (bacteremias, pneumonias, soft tissue infections, and osteomyelitis) is unknown. This was a retrospective study of patients on maintenance hemodialysis from a single, urban dialysis center to assess the long-term impact of the higher cumulative use of IV iron, on the incidence of clinically important infections. Our iron protocol was modified in June 2010 to aim for TSAT >30% unless serum ferritin levels were >1200 ng/mL. Data from only those patients who had been on dialysis for the whole duration between June 2009 and May 2011 were included. A total of 140 patients with end-stage renal disease on hemodialysis patients were found to be eligible for the study. There was a statistically significant increase in the mean TSAT and mean serum ferritin with the new anemia management protocol with a significant decrease in the mean erythropoiesis stimulating agent dose requirement. There was no statistically significant increase in the incidence of infectious complications. Although in vitro effects of iron are known to stimulate bacterial growth, a higher IV dose of iron may not increase the risk of infection in such patients. PMID:22832501

  12. Safety and efficacy of intravenous iron therapy in reducing requirement for allogeneic blood transfusion: systematic review and meta-analysis of randomised clinical trials

    PubMed Central

    2013-01-01

    Objectives To evaluate the efficacy and safety of intravenous iron, focusing primarily on its effects on haemoglobin, requirement for transfusion, and risk of infection. Design Systematic review and meta-analysis of randomised controlled trials investigating the safety and efficacy of intravenous iron therapy. Data sources Randomised controlled trials from Medline, Embase, and the Cochrane Central Register of Controlled Trials from 1966 to June 2013, with no language restrictions. Eligibility criteria for selecting studies Eligible trials were randomised controlled trials of intravenous iron compared with either no iron or oral iron. Crossover and observational studies were excluded. Main outcome measures Change in haemoglobin concentration and risk of allogeneic red blood cell transfusion (efficacy) and risk of infection (safety). Results Of the 75 trials meeting the inclusion criteria, 72 studies including 10 605 patients provided quantitative outcome data for meta-analysis. Intravenous iron was associated with an increase in haemoglobin concentration (standardised mean difference 6.5 g/L, 95% confidence interval 5.1 g/L to 7.9 g/L) and a reduced risk of requirement for red blood cell transfusion (risk ratio 0.74, 95% confidence interval 0.62 to 0.88), especially when intravenous iron was used with erythroid stimulating agents (ESAs) or in patients with a lower baseline plasma ferritin concentration. There were no significant interactions between the efficacy of intravenous iron and type or dose administered. Intravenous iron was, however, associated with a significant increase in risk of infection (relative risk 1.33, 95% confidence interval 1.10 to 1.64) compared with oral or no iron supplementation. The results remained similar when only high quality trials were analysed. Conclusions Intravenous iron therapy is effective in increasing haemoglobin concentration and reducing the risk of allogeneic red blood cell transfusion and could have broad applicability to a range of acute care settings. This potential benefit is counterbalanced by a potential increased risk of infection. PMID:23950195

  13. Outcomes and prognostic factors of first relapsed acute promyelocytic leukemia patients undergoing salvage therapy with intravenous arsenic trioxide and chemotherapy.

    PubMed

    Lou, Yinjun; Suo, Shanshan; Tong, Yin; Tong, Hongyan; Qian, Wenbin; Meng, Haitao; Mai, Wenyuan; Huang, Jian; Yu, Wenjuan; Jin, Jie

    2014-06-01

    Arsenic trioxide (ATO) is an effective therapy for relapsed acute promyelocytic leukemia (APL) patients; however, the optimal treatment strategy remains unclear, and knowledge of the prognostic factors is still limited. We retrospectively analyzed the outcomes of 64 consecutive first relapsed APL patients (12 with molecular relapse and 52 with hematologic relapse). Patients received re-induction with intravenous ATO-based regimens. Patients who achieved a CR2 were offered further courses of alternating ATO/conventional chemotherapy with or without stem cell transplantation (SCT). With a median follow-up of 27 months (range, 6-57) in the molecular relapsed subgroup, the 3-year relapse-free survival (RFS) and overall survival (OS) rates were 81.5 % and 100 %, respectively. With a median follow-up of 38 months (range, 0-129) in the hematologic relapse group, the 3-year RFS and OS rates were 57.1 % and 72.1 %, respectively. Furthermore, in the hematologic relapse group, we compared the outcome between relapsed patients after previous ATO therapy (n?=?20) with those who did not receive prior ATO therapy (n?=?32). The CR2 rate was 80 % (16/20) vs. 93.8 % (30/32), (p?=?0.189). However, the relapse rate was 68.8 % (11/16) vs. 33.3 % (10/30), (p?=?0.03). The 4-year OS rate was 62.4 % vs. 71.2 %, (p?=?0.816), and the 4-year RFS rate was 29.8 % vs. 66.2 % (p?=?0.023). The results indicate that, irrespective of frontline therapy with ATO, salvage therapy with an ATO-based regimen remains effective. However, the long-term survival for those patients who received previous ATO-based treatment was inferior compared to those who did not receive prior ATO. In addition, the alternating ATO/chemotherapy strategy can be a post-remission treatment option in a subset of patients. PMID:24408159

  14. Transesophageal echocardiography: an objective tool in defining maximum ventricular response to intravenous fluid therapy.

    PubMed

    Swenson, J D; Harkin, C; Pace, N L; Astle, K; Bailey, P

    1996-12-01

    Ventricular preload is an important determinant of cardiac function, which is indirectly measured in the clinical setting by the pulmonary capillary wedge pressure (PCWP). Transesophageal echocardiography (TEE) is rapidly gaining acceptance as a monitor of cardiac function. Although it provides high-resolution images of cardiac structures, clinical assessment of ventricular preload using TEE has been subjective, since quantitative measurements have been difficult to perform in a timely fashion. Automated border detection (ABD) is a new technology used in conjunction with TEE that allows quantitative real-time, two-dimensional measurement of cavity areas. To determine whether enddiastolic area (EDA) measured by ABD can be used to determine an appropriate end point for intravenous fluid administration, nine mongrel dogs were studied. Anesthetized animals were hemorrhaged to achieve a central venous pressure of 0-5 mm Hg. Each animal was then given intravenous fluid (autologous blood followed by hetastarch) until a peak in thermodilution cardiac output (CO) was achieved. Measures of PCWP, EDA, CO, and left ventricular stroke work (LVSW) were obtained after each fluid bolus. Bivariate plots displaying administered volume versus CO, LVSW, and EDA revealed parallel curves for each of these variables with peaks evident at cumulative volumes of 50-55 mL/kg. Multiple regression with mixed model analysis of covariance was performed to determine the significance of EDA in relation to changes in CO and LVSW. Analysis was likewise performed comparing the relationship between PCWP and changes in CO or LVSW. A significant relationship was demonstrated when comparing EDA to changes in CO and LVSW (P = 0.03 and P < 0.0001, respectively). Similar analysis comparing PCWP to changes in CO and LVSW failed to demonstrate a significant relationship (P = 0.54 and P = 0.36, respectively). These data suggest that changes in EDA measured using TEE with ABD are related to trends in cardiac function and can suggest an appropriate end point for intravenous fluid administration as defined by maximum CO and LVSW. PCWP did not demonstrate a significant relationship to changes in CO and LVSW. PMID:8942577

  15. Successful response to intravenous immunoglobulin as rescue therapy in a patient with Hashimoto's encephalopathy

    PubMed Central

    Cornejo, Rodrigo; Venegas, Pablo; Goñi, Daniela; Salas, Alvaro; Romero, Carlos

    2010-01-01

    The authors describe the case of a 61-year-old woman who was admitted to our intensive care unit (ICU) due to impaired consciousness associated with generalised seizures. Her cerebrospinal fluid, electrolytes, acid-base analysis, and common laboratory and toxicology tests were normal. An MRI ruled out the presence of stroke or haemorrhage but showed severe leukoencephalopathy. Parkinson's disease, Creuzfeld–Jacob disease, vascular alterations, cancer, and rheumatological and metabolic diseases were evaluated and excluded. In view of her history of hypothyroidism despite adequate hormonal replacement and clinical behaviour, Hashimoto's encephalopathy was considered. Anti-thyroperoxidase levels were above 3000 IU/ml. The patient received 5 g of methylprednisolone followed by prednisone, but after a favourable initial response, returned to a comatose state. However, after administration of intravenous immunoglobulin (IVIG) 2 g/kg, the patient recovered with resolution of neurological symptoms and was discharged from the ICU 4 days after finishing IVIG treatment. PMID:22802479

  16. Photoacoustic imaging of intravenously injected photosensitizer in rat burn models for efficient antibacterial photodynamic therapy

    NASA Astrophysics Data System (ADS)

    Tsunoi, Yasuyuki; Sato, Shunichi; Ashida, Hiroshi; Terakawa, Mitsuhiro

    2012-02-01

    For efficient photodynamic treatment of wound infection, a photosensitizer must be distributed in the whole infected tissue region. To ensure this, depth profiling of a photosensitizer is necessary in vivo. In this study, we applied photoacoustic (PA) imaging to visualize the depth profile of an intravenously injected photosensitizer in rat burn models. In burned tissue, pharmacokinetics is complicated; vascular occlusion takes place in the injured tissue, while vascular permeability increases due to thermal invasion. In this study, we first used Evans Blue (EB) as a test drug to examine the feasibility of photosensitizer dosimetry based on PA imaging. On the basis of the results, an actual photosensitizer, talaporfin sodium was used. An EB solution was intravenously injected into a rat deep dermal burn model. PA imaging was performed on the wound with 532 nm and 610 nm nanosecond light pulses for visualizing vasculatures (blood) and EB, respectively. Two hours after injection, the distribution of EB-originated signal spatially coincided well with that of blood-originated signal measured after injury, indicating that EB molecules leaked out from the blood vessels due to increased permeability. Afterwards, the distribution of EB signal was broadened in the depth direction due to diffusion. At 12 hours after injection, clear EB signals were observed even in the zone of stasis, demonstrating that the leaked EB molecules were delivered to the injured tissue layer. The level and time course of talaporfin sodium-originated signals were different compared with those of EB-originated signals, showing animal-dependent and/or drug-dependent permeabilization and diffusion in the tissue. Thus, photosensitizer dosimetry should be needed before every treatment to achieve desirable outcome of photodynamic treatment, for which PA imaging can be concluded to be valid and useful.

  17. Intratympanic dexamethasone with hyaluronic acid in the treatment of idiopathic sudden sensorineural hearing loss after failure of intravenous steroid and vasoactive therapy

    Microsoft Academic Search

    Haralampos Gouveris; Oksana Selivanova; Wolf Mann

    2005-01-01

    The purpose of this prospective study was to test whether intratympanic application of dexamethasone\\/hyaluronic acid improves hearing outcome in patients with pantonal idiopathic sudden sensorineural hearing loss (ISSHL), in patients with sudden deafness or sudden profound SHL and in patients with predominant high-frequency ISSHL who are refractory to intravenous steroid and vasoactive therapy. The study took place in an academic

  18. Vacuum-assisted therapy accelerates wound healing in necrotizing soft tissue infections: our experience in two intravenous drug abuse patients.

    PubMed

    Marinis, Athanasios; Voultsos, Mavroudis; Grivas, Paraskevas; Dikeakos, Panagiotis; Liarmakopoulos, Emmanouil; Paschalidis, Nikolaos; Rizos, Spyros

    2013-12-01

    Negative pressure wound therapy using vacuum-assisted closure (VAC) devices is currently a well established technique for managing complicated wounds. Such wounds occur after aggressive surgical debridement for necrotizing soft tissue infections (NSTI). In this report we present our experience in two intravenous drug abusers managed with VAC for NSTIs. The patients were 25 and 34 years old, HCV positive and presented with oedema of the upper femoral compartments and concomitant severe sepsis. Ultrasonography and computed tomography revealed severe cellulitis, fluid collection and necrosis of the affected fasciae and muscles. After emergent and subsequent aggressive surgical debridement during the first 48h, the VAC device was applied. Both patients had an uncomplicated postoperative course and a fast recovery from their multiorgan dysfunction. Suture closure of the wounds was achieved at the 25th and 38th postoperative days respectively and patients were discharged without any motor deficit. Negative pressure wound therapy is a modern therapeutic modality for treating complicated infected wounds. Moreover, it accelerates wound healing and primary closure, facilitating patient ambulation and recovery. A dedicated medical and nursing team is an important prerequisite for a successful outcome. PMID:24335462

  19. Multicenter study of intravenous busulfan, cyclophosphamide, and etoposide (i.v. Bu\\/Cy\\/E) as conditioning regimen for autologous stem cell transplantation in patients with non-Hodgkin's lymphoma

    Microsoft Academic Search

    J G Kim; S K Sohn; Y S Chae; D H Yang; J-J Lee; H-J Kim; H J Shin; J S Jung; W S Kim; D H Kim; C Suh; S J Kim; H-S Eom; S H Bae

    2007-01-01

    The current study aimed to evaluate the efficacy and toxicity of a combination of intravenous busulfan, cyclophosphamide and etoposide (i.v. Bu\\/Cy\\/E) as a conditioning regimen prior to autologous hematopoietic stem cell transplantation in patients with non-Hodgkin's lymphoma (NHL). Sixty-four patients with relapsed\\/refractory (n=36) or high-risk (n=28) lymphoma were enrolled. The high-dose chemotherapy consisted of i.v. Bu (0.8 mg kg?1 i.v.

  20. [Systemic infusion therapy versus retrograde intravenous perfusion: comparative results in patients with diabetic neuropathic plantar ulcer].

    PubMed

    Seidel, C; Bühler-Singer, S; Richter, U G; Hornstein, O P

    1993-01-01

    Concerning the resistance of diabetic neuropathic plantar ulcers (DNPU) against systemically applied drugs, the "Retrograde Venous Perfusion" (RVP) was introduced as a therapeutic alternative by C. P. Ferreira in 1988. An isotonic saline solution containing gentamycin, buflomedil, dexamethasone, heparin and lignocain is injected into a dorsal foot vein under arterial occlusion of the lower leg. In the present study RVP treatment was done in 20 patients with DNPU and the results were compared to a group treated with systemic intravenous infusions (SVI; n = 20). After 10 days of treatment, 8 out of 20 ulcers were closed (SVI: 4). In 9 ulcers (SVI: 4) size had diminuted by > 30%. Non responders were not observed under RVP in contrast to SVI (7/20 cases). In 4 of 5 patients with osteolytic bone lesions (SVI: 0/7), partial restoration was observed. Rate of toe amputation dropped to 0% (SVI: 20%). Considering the striking differences between either regimen, RVP can be recommended for treatment of DNPU especially when complicated by osteomyelitis. PMID:8379178

  1. Type IV renal tubular acidosis and spironolactone therapy in the elderly.

    PubMed Central

    O'Connell, J. E.; Colledge, N. R.

    1993-01-01

    Spironolactone therapy is a well-known cause of hyperkalaemia, but in susceptible patient, it may also be associated with metabolic acidosis. We report a case of severe renal tubular acidosis (Type IV) with life-threatening hyperkalaemia caused by spironolactone, and discuss the mechanisms by which this may occur. PMID:8290440

  2. Guidelines for the use of intravenous thrombolytic agents in acute myocardial infarction. Ontario Medical Association Consensus Group on Thrombolytic Therapy.

    PubMed Central

    Naylor, C D; Armstrong, P W

    1989-01-01

    A consensus group convened under the auspices of the Ontario Medical Association produced guidelines for the use of intravenous thrombolytic agents in acute myocardial infarction. The guidelines, updated to December 1988, include the following points. 1) Any hospital that routinely accepts the responsibility for looking after patients with acute myocardial infarction could offer thrombolytic therapy if monitoring facilities are available and if the staff are experienced in the treatment of cardiac rhythm disturbances. 2) Before treatment, all patients must be carefully screened for factors predisposing to hemorrhagic complications. 3) A physician should be clearly designated as responsible for the care of the patient receiving an infusion and be available in the event of problems. 4) For the two approved agents the usual dosages are as follows: streptokinase, 1.5 million units given over 1 hour; and tissue-type plasminogen activator (tPA), 100 mg over 3 hours, delivered as 60 mg in the first hour (of which 6 to 7 mg should be given as a bolus in the first 1 to 2 minutes) and then an infusion of 20 mg/h over the next 2 hours. 5) Intravenous thrombolytics should be considered for any patient with presumed acute myocardial infarction, as suggested by prolonged chest pain or other appropriate symptoms and typical electrocardiographic changes. Expeditious treatment is critical, since myocardial necrosis occurs within hours. 6) Emergency angiography is indicated for patients with hemodynamic compromise and no apparent response to streptokinase or tPA and in those with recurrent chest pain suggestive of acute myocardial infarction despite an apparent response to intravenous thrombolysis. Angiography before discharge is recommended for patients with postinfarction angina or evidence from noninvasive testing of significant residual ischemic risk. 7) There is insufficient evidence to choose between streptokinase and tPA on the basis of the two most important outcome measures: patient survival and myocardial preservation. More conclusive evidence comparing tPA, streptokinase and another promising agent, acylated plasminogen-streptokinase activator complex, will be available in 1989-90. PMID:2497946

  3. Prediction of Resistance to Standard Intravenous Immunoglobulin Therapy in Kawasaki Disease

    PubMed Central

    Lee, Sang Min; Lee, Jeong Bong; Go, Young Bin; Song, Ho Young; Lee, Byung Jin

    2014-01-01

    Background and Objectives Ten to twenty percent of children with Kawasaki disease (KD) do not respond to initial intravenous immunoglobulin (IVIG) treatment. If untreated, approximately 15% to 25% of KD patients have complications. The aim of this study was to find useful predictors of responsiveness to initial IVIG treatment in KD. Subjects and Methods We retrospectively reviewed medical records of 91 children diagnosed with KD at Myong Ji Hospital from March 2012 to April 2014. Before and after (24 hours to 36 hours) IVIG treatment, the following laboratory data were obtained: hemoglobin (Hb) level, white blood cell count, proportion of neutrophil, lymphocyte and eosinophil, platelet count, erythrocyte sedimentation rate (ERS), C-reactive protein (CRP), creatine kinase (CK), creatine kinase MB (CK-MB), and N-terminal pro-brain natriuretic peptide (NT-proBNP). Subjects were then divided into two groups: IVIG-responsive or IVIG-resistant. Results Of 91 patients, 11 (12%) required retreatment. By univariate analysis, before-IVIG laboratory parameters of white blood cell count, % neutrophil, ERS, CRP, sodium, CK, CK-MB, and NT-proBNP were significantly different between IVIG-responsive and IVIG-resistant patient groups. In the after-IVIG laboratory parameters, Hb level, white blood cell count, % neutrophil, % lymphocyte, CRP, CK, CK-MB, and NT-pro-BNP were significantly different between the two groups. While the mean-differences were not statistically significant, fractional change (FC)-CRP and FC-% neutrophil showed significant difference. By multivariate analysis, FC-CRP was confirmed to be an independent predictor for initial IVIG resistance. Conclusion Fractional change-C-reactive protein might be a useful and important value for predicting initial IVIG resistance in KD patients. PMID:25469144

  4. Flebogamma 5% DIF development: rationale for a new option in intravenous immunoglobulin therapy.

    PubMed

    Jorquera, J I

    2009-09-01

    Flebogamma 5% dual inactivation and filtration (DIF), a new 5% liquid intravenous immunoglobulin with a stability of 2 years when stored at temperatures between 2 and 30 degrees C, has been developed. This new product is the result of the accumulated experience provided by Flebogamma, with more than 30 million grams administered since 1992 in Europe and the United States, and the implementation of the latest technology to improve Flebogamma even more by increasing its viral safety margin further. In addition to the specific inactivation stage for Flebogamma 5% (pasteurization), the new process includes a solvent-detergent treatment and nanofiltration through a Planova filter down to 20 nm. The preparation presents a mean purity of 99.6 +/- 0.2% with a correct chromatographic profile. Percentage values of immunoglobulin (Ig)G subclasses are equivalent to the physiological values of normal serum. The content in IgA as well as other possible impurities is very low, and the product presents a mean result of 109 +/- 5% in the Fc fragment functionality assay, demonstrating the integrity of the IgG molecule. The functionality is also reflected in neutralization tests carried out against poliomyelitis, diphtheria, measles and vaccinia which, apart from the antibody titres determined by enzyme-linked immunosorbent assay, guarantees that antibodies are capable of reacting against these pathogens. Regarding safety, the combination of multiple methods with capacity to inactivate or remove biological agents which include chemical inactivation, heat inactivation, nanofiltration and precipitations, with very different mechanisms of action, provides Flebogamma 5% DIF very wide margins of safety regarding to potential pathogens. PMID:19630865

  5. Acute therapy with intravenous omeprazole on caustic esophageal injury: a prospective case series.

    PubMed

    Cakal, B; Akbal, E; Köklü, S; Babal?, A; Koçak, E; Ta?, A

    2013-01-01

    The ingestion of caustic substances may result in significant esophageal injury. There is no standard treatment protocol for esophageal injury and most patients are treated with a proton pump inhibitor or H2 antagonist. However, there is no clinical study evaluating the efficacy of omeprazole for caustic esophageal injury. A prospective study of 13 adult patients (>18 years of age) who were admitted to our hospital for caustic ingestion between May 2010 and June 2010 was conducted. Mucosal damage was graded using a modified endoscopic classification described by Zargar et al. Patients were treated with a proton pump inhibitor and maintained without oral intake until their condition was considered stable. Patients received omeprazole 80 mg in bolus IV, followed by continuous infusion of 8 mg/hour for 72 hours. A control endoscopy was performed 72 hours after admission. There was significant difference regarding endoscopic healing between the before and after omeprazole infusion (P?=?0.004). There was no hospital mortality at the follow-up. Omeprazole may effectively be used in the acute phase treatment of caustic esophagus injuries. PMID:22332893

  6. Modulation of Total Body Irradiation Induced Life Shortening by Systemic Intravenous MnSOD-Plasmid Liposome Gene Therapy

    PubMed Central

    Epperly, Michael W.; Smith, Tracy; Wang, Hong; Schlesselman, James; Franicola, Darcy; Greenberger, Joel S.

    2008-01-01

    To determine whether systemic administration of MnSOD-PL protected mice from the acute hematopoietic syndrome as well as delayed death following total body irradiation (TBI), C57BL/6J mice received intravenously 100?l liposomes containing 100?g of human MnSOD-transgene plasmid 24 hours prior to 9.5 Gy or 1.0 Gy. The dose of 9.5 Gy was lethal to 42% of irradiated control female and 74% of irradiated control male mice respectively at 30 days with bone marrow hypocellularity consistent with the hematopoietic syndrome. A statistically significant increase in survival was detected in MnSOD-PL treated compared to 9.5 Gy irradiated control female mice out to 400 days, and in male mice out to 340 days. The incidence of tumors was similar between surviving groups. Between 350 to 600 days, outcome was similar for both MnSOD-PL treated and control irradiated groups consistent with aging with no difference in gross or microscopic pathologic evidence of tumors. Male and female mice receiving 1.0 Gy TBI showed irradiation induced life shortening after 120 days that was decreased by MnSOD-PL administration, and was associated with no increase in rate of tumor associated death. Therefore, systemic MnSOD-PL radioprotective gene therapy is not associated with a detectably higher incidence of late carcinogenesis. PMID:19024650

  7. Intravenous Iron Versus Oral Iron in the Treatment of Postpartum Iron Deficiency Anemia

    Microsoft Academic Search

    Meghan Crowley

    2010-01-01

    Background: Postpartum anemia can develop after delivery because of unforeseen medical problems during and after delivery which could complicate a mother’s ability to properly care for her newborn child. The current treatment for postpartum anemia is oral iron supplementation but this treatment has been associated with several gastrointestinal side effects. Alternative treatments include blood transfusions and intravenous (IV) iron therapy.

  8. Early and intermediate prognosis of intravenous thrombolytic therapy in acute ischemic stroke subtypes according to the causative classification of stroke system

    PubMed Central

    Pashapour, Ali; Atalu, Abolfazl; Farhoudi, Mehdi; Taheraghdam, Ali-Akbar; Sadeghi Hokmabadi, Elyar; Sharifipour, Ehsan; NajafiNeshli, Mehdi

    2013-01-01

    Objectives: Intravenous thrombolytic therapy has established acceptable results in treating ischemic stroke. However, there is little information on treatment outcome especially in different subtypes. The aim of current study was to evaluate early and intermediate prognosis in intravenous thrombolytic therapy for acute ischemic stroke subtypes. Methodology: Forty eligible patients (57.5% male with mean age of 63.18±13.49 years) with definite ischemic stroke who were admitted to emergency department of Imam Reza University Hospital, in the first 180 minutes after occurrence received recombinant tissue plasminogen activator. All investigation findings were recorded and stroke subtypes were determined according to the Causative Classification of Stroke System. Stroke severity forms including modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) scores were recorded for all patients in first, seven and 90 days after stroke and disease outcome was evaluated. Results: The etiology of stroke was large artery atherosclerosis in 20%, cardio-aortic embolism in 45%, small artery occlusion in 17.5% and undetermined causes in 17.5%. NIHSS and mRS scores were significantly improved during time (P < 0.001 in both cases). Three months mortality rate was 25%. Among the etiologies, patients with small artery occlusion and then cardio-aortic embolism had lower NIHSS score at arrival (P = 0.04). Caplan-meier analysis showed that age, sex and symptom to needle time could predict disease outcome. Conclusion: Intravenous thrombolytic therapy is accompanied by good early and intermediate outcome in most patients with ischemic stroke. Small artery occlusion subtype had less disease severity and higher improvement. PMID:24353536

  9. Intravenous Solutions for Exploration Missions

    NASA Technical Reports Server (NTRS)

    Miller, Fletcher J.; Niederhaus, Charles; Barlow, Karen; Griffin, DeVon

    2007-01-01

    This paper describes the intravenous (IV) fluids requirements being developed for medical care during NASA s future exploration class missions. Previous research on IV solution generation and mixing in space is summarized. The current exploration baseline mission profiles are introduced, potential medical conditions described and evaluated for fluidic needs, and operational issues assessed. We briefly introduce potential methods for generating IV fluids in microgravity. Conclusions on the recommended fluid volume requirements are presented.

  10. Venipuncture and intravenous infusion access during zero-gravity flight

    NASA Technical Reports Server (NTRS)

    Krupa, Debra T.; Gosbee, John; Billica, Roger; Bechtle, Perry; Creager, Gerald J.; Boyce, Joey B.

    1991-01-01

    The purpose of this experiment is to establish the difficulty associated with securing an intravenous (IV) catheter in place in microgravity flight and the techniques applicable in training the Crew Medical Officer (CMO) for Space Station Freedom, as well as aiding in the selection of appropriate hardware and supplies for the Health Maintenance Facility (HMF). The objectives are the following: (1) to determine the difficulties associated with venipuncture in a microgravity environment; (2) to evaluate the various methods of securing an IV catheter and attached tubing for infusion with regard to the unique environment; (3) to evaluate the various materials available for securing an intravenous catheter in place; and (4) to evaluate the fluid therapy administration system when functioning in a complete system. The inflight test procedures and other aspects of the KC-135 parabolic flight test to simulate microgravity are presented.

  11. Cost of post-operative intravenous iron therapy in total lower limb arthroplasty: a retrospective, matched cohort study

    PubMed Central

    Muñoz, Manuel; Gómez-Ramírez, Susana; Martín-Montañez, Elisa; Naveira, Enrique; Seara, Javier; Pavía, José

    2014-01-01

    Background Requirements for allogeneic red cell transfusion after total lower limb arthroplasty are still high (20–50%), and post-operative intravenous iron has been shown to reduce transfusion requirements for this surgery. We performed a cost analysis to ascertain whether this alternative is also likely to be cost-effective. Materials and methods Data from 182 matched-pairs of total lower limb arthroplasty patients, managed with a restrictive transfusion protocol and without (control group) or with post-operative intravenous iron (iron group), were retrospectively reviewed. Acquisition and administration costs of iron (iron sucrose or ferric carboxymaltose) and allogeneic red cell concentrates, haemoglobin measurements, and prolonged stay in hospital were used for blood management cost analysis. Results Patients in the iron group received 600 mg intravenous iron, without clinically relevant incidents, and had a lower allogeneic transfusion rate (11.5% vs 26.4% for the iron and control groups, respectively; p=0.001). The reduction in transfusion rate was more pronounced in anaemic patients (17% vs 40%; p=0.015) than in non-anaemic ones (9.6% vs 21.2%; p=0.011). There were no differences with respect to post-operative infection rate. Patients receiving allogeneic transfusion stayed in hospital longer (+1.9 days [95% CI: 1.2–2.6]). As intravenous iron reduces the allogeneic transfusion rate, both iron formulations were cost-neutral in the different cost scenarios (?25.5 to 62.1 €/patient for iron sucrose, and ?51.1 to 64.4 €/patient for ferric carboxymaltose). Discussion In patients presenting with or without pre-operative anaemia, post-operative intravenous iron after total lower limb arthroplasty seems to be safe and is associated with reduced transfusion rates, without incremental costs. For anaemic patients, its efficacy could be increased by associating some other blood-saving method. PMID:24120595

  12. Crystalline-Like Keratopathy after Intravenous Immunoglobulin Therapy with Incomplete Kawasaki Disease: Case Report and Literature Review

    PubMed Central

    Kocabas, Emine; Taylan Sekeroglu, Hande; Özgür, Özlem; Yagmur, Meltem; Ersoz, T. Reha

    2013-01-01

    A 7-year-old girl had presented with high body temperature and joint pain which continued for 3 days. Because of the prolonged history of unexplained fever, rash, bilateral nonpurulent conjunctival injection, oropharyngeal erythema, strawberry tongue, and extreme of age, incomplete Kawasaki disease was considered and started on an intravenous immunoglobulin infusion. Six days after this treatment, patient was referred to eye clinic with decreased vision and photophobia. Visual acuity was reduced to 20/40 in both eyes. Slit-lamp examination revealed bilateral diffuse corneal punctate epitheliopathy and anterior stromal haze. Corneal epitheliopathy seemed like crystal deposits. One day after presentation, mild anterior uveitis was added to clinical picture. All ocular findings disappeared in one week with topical steroid and unpreserved artificial tear drops. We present a case who was diagnosed as incomplete Kawasaki disease along with bilateral diffuse crystalline-like keratopathy. We supposed that unusual ocular presentation may be associated with intravenous immunoglobulin treatment. PMID:23607016

  13. [A case of stage IV breast cancer responding to S-1 therapy after FEC and PTX therapies].

    PubMed

    Aoyagi, Haruhiko; Kaneko, Jun; Makinose, Takamichi; Someno, Yasunori; Katsuta, Eriko; Saguchi, Morihito; Okubo, Katsuhiko; Hamada, Setsuo; Sekine, Takeshi; Sato, Takanobu; Sugihara, Kenichi; Maejima, Shizuaki

    2009-11-01

    In November 2005, a 34-year-old female presented to our department with a bleeding tumor on her right breast. She noticed the tumor approximately two years ago but she left it untreated. An exposed tumor was observed with a diameter of approximately 8 cm located in the right breast. It was diagnosed as invasive ductal carcinoma by biopsy (ER (+), PgR (+), and HERS2: 1 +). The imaging showed multiple metastases to the bilateral lungs, right axillary lymph node, mediastinal lymph node and sternal. The diagnosis was made as right breast cancer (T4c, N3c, M1, and stage IV). The patient received 4 courses of FEC therapy and 4 courses of PTX therapy. The patient had a partial response (PR). However, tumor markers were elevated in September 2006. Thus, an administration of S-1 was initiated. The size of the tumor shown in the imaging was reduced, and the patient had a PR. Since December 2008, tumor markers have been elevated again. However, the patient has had SD in the imaging and S-1 administrations have been continued. A total of 24 courses have been performed to the present time, and the patient's conditions have not been aggravated in approximately 3 years and 5 months. She has maintained a good QOL and is being followed up on an outpatient basis. S-1 administrations can be an effective treatment for advanced breast cancer resistant to anthracycline and taxane when considering a satisfactory QOL of patients. PMID:20037460

  14. Combination Therapy with Intravenous Colistin for Management of Infections Due to Multidrug-Resistant Gram-Negative Bacteria in Patients without Cystic Fibrosis

    PubMed Central

    Kasiakou, Sofia K.; Michalopoulos, Argyris; Soteriades, Elpidoforos S.; Samonis, George; Sermaides, George J.; Falagas, Matthew E.

    2005-01-01

    Colistin, an antibiotic almost abandoned for intravenous administration for many years due to its reported toxicity, has been recently reintroduced in clinical practice due to the emergence of multidrug-resistant gram-negative bacteria and the lack of development of new antibiotics to combat them. To assess the safety and effectiveness of intravenous colistin, in combination with other antimicrobial agents, in the treatment of serious infections in patients without cystic fibrosis, a retrospective cohort study in a 450-bed tertiary-care hospital in Athens, Greece, was performed. Patients who were hospitalized from 1 October 2000 to 31 January 2004 and received intravenous colistin for more than 72 h were further analyzed. The primary outcome measure was the in-hospital mortality; secondary end points were the clinical outcome of the infections and the occurrence of colistin toxicity. Fifty patients received intravenous colistin with a median (mean) daily dose of 3 (4.5) million IU for 16.5 (21.3) days for the management of 54 episodes of infections due to multidrug-resistant gram-negative bacteria. The predominant infections were pneumonia (33.3%), bacteremia (27.8%), urinary tract infection (11.1%), and intra-abdominal infection (11.1%). The responsible pathogens were Acinetobacter baumannii (51.9%), Pseudomonas aeruginosa (42.6%), and Klebsiella pneumoniae (3.7%) strains (no pathogen was isolated from one case). In-hospital mortality was 24% (12/50 patients). Clinical response (cure or improvement) of the infection was observed in 66.7% of episodes (36/54). In the studied group, serum creatinine levels were decreased, at the end of colistin treatment, by an average of 0.2 ± 1.3 mg/dl compared to baseline levels. Deterioration of renal function during colistin therapy was observed in 4/50 patients (8%). Coadministration of other antimicrobial agents with spectrum against gram-negative microorganisms and the absence of a control group constitute the major limitations of this study. The use of intravenous colistin for the treatment of infections due to multidrug-resistant gram-negative bacteria appears to be safe and effective. PMID:16048915

  15. Intracoronary versus Intravenous Administration of Abciximab in Patients with Acute Coronary Syndrome: A Meta-Analysis

    PubMed Central

    Hou, An-Ji; Yuan, Hai-Bo; Zheng, Yan; Zhou, Yu-Hao

    2013-01-01

    Background Abciximab is a widely used adjunctive therapy for acute coronary syndrome (ACS). However, the effect of intracoronary (IC) administration of abciximab on cardiovascular events remains unclear when compared with intravenous (IV) therapy. Methodology and Principal Findings We systematically searched the Medline, Embase, and Cochrane Central Register of Controlled Trials databases and reference lists of articles and proceedings of major meetings for obtaining relevant literature. All eligible trials included ACS patients who received either IC administration of abciximab or IV therapy. The primary outcome was major cardiovascular events, and secondary outcomes included total mortality, reinfarction, and any possible adverse events. Of 660 identified studies, we included 9 trials reporting data on 3916 ACS patients. Overall, IC administration of abciximab resulted in 45% reduction in relative risk for major cardiovascular events (RR; 95% confidence interval [CI], 24?60%), 41% reduction in RR for reinfarction (95% CI, 7?63%), and 44% reduction in RR for congestive heart failure relative to IV therapy (95% CI, 8?66%); however, compared to IV therapy, IC administration of abciximab had no effect on total mortality (RR, 0.69; 95% CI, 0.45?1.07). No other significant differences were identified between the effect of IC abciximab administration and IV therapy. Conclusions/Significance IC administration of abciximab can reduce the risk of major cardiovascular events, reinfarction, and congestive heart failure when compared with IV therapy. PMID:23469144

  16. [Potential therapy of intravenous neural stem cell transplantation for psychiatric disorder--a strategy for facilitation of neural network and behavioral recovery].

    PubMed

    Shirasaka, Tomohiro; Kurosawa, Shigeki

    2014-10-01

    Recent clinical neuroimaging studies have revealed a possible relationship between morphological brain changes and the manifestation of psychiatric disorders such as depression, schizophrenia, and alcoholism. Although its biological mechanism is still unclear, the emerging evidence suggests that the alteration of neurogenesis is the key factor for the morphological brain changes of these psychiatric disorders. In our previous work, we analyzed the mechanism of neural network disruption by ethanol using cultured cells, and found a suppressive effect of ethanol on neural stem cell (NSC) differentiation. While, we also demonstrated that antidepressants, mood stabilizers and atypical antipsychotics stimulate NSC differentiation which was inhibited by ethanol. In the present work, we have demonstrated that the usefulness of intravenous transplantation of NSCs to fetal alcohol spectrum disorder (FASD) model rat for the purpose of reconstructing the impaired neural network and investigating the possibility of regenerative therapy for patients with neurobehavioral deficits of FASD. We have shown the potential migration of transplanted NSCs into the brain by visualizing a fluorescent cell marker and radioisotope, as well as the possible recovery of behavioral abnormalities observed in FASD model rats, such as memory/cognitive function, and social interaction. We further assessed the characteristics of transplanted cells in the brain and found that the GABAergic interneurons were increased in amygdale, DG, cingulated cortex areas in the model rat. In the amygdala and cingulate Cortex of model rats, number of parvalbumin positive cells was reduced and the NSC transplantation recovered these disturbances. Moreover, in the amygdala and cingulate cortex, intravenous NSC transplantation appears to regenerate expression of post-synaptic density protein 95 (PSD95) in FASD model rats. These results indicate that intravenous NSC transplantation has the potential to become a therapeutic intervention for FASD patients. PMID:25651620

  17. Circulatory kinetics of intravenously injected {sup 238}Pu(IV) citrate and {sup 14}C-CaNa{sub 3}-DTPA in mice: Comparison with rat, dog, and Reference Man

    SciTech Connect

    Durbin, P.W.; Kullgren, B.; Schmidt, C.T. [Lawrence Berkeley National Lab., CA (United States)

    1997-02-01

    New ligands for in vivo chelation of Pu(IV) are being synthesized and evaluated in mice for efficacy and toxicity. Biokinetic studies of the new ligands, CaNa{sub 3}-DTPA, and Pu(IV) are major components of those investigations. Young adult female mice were injected intravenously (iv) with {sup 3}H-inulin, {sup 14}C-CaNa{sub 3}-DTPA, or {sup 238}Pu(IV) citrate to provide base- line data for plasma clearance, tissue uptake, and excretion rates and to determine the dilution volume (VOD) and renal clearance rate (RC) of filterable substances. Published plasma clearance data in Reference Man, dog, and rat were collected. Based on combined data for {sup 3}H-inulin and {sup 14}C-CaNa{sub 3}-DTPA, VOD = 17% of body weight and RC = 18 mL kg{sup -1} min{sup -1} for mice. Retention of {sup 14}C-CaNa{sub 3}-DTPA in the four species is proportional to body weight and inversely proportional to RC: Integrals of the retention of {sup 14}C-CaNa{sub 3}-DTPA from R(t) = 1.0 to R(t) = 0.05 are 108, 43, 28, and 10 DF min, respectively, for Reference Man, dog, rat, and mouse. Clearances of iv-injected Pu(IV) citrate from plasma are in the same order: The plasma curve integrals from injection to 1440 min are 840, 640, 280, and 67 DF min, respectively, for Reference Man, dog, rat, and mouse. In mice, a large fraction of newly injected Pu(IV) is rapidly transferred to the interstitial water of bulk soft tissue (excluding liver and kidneys), from which it is cleared at the same rate as from the plasma. Rapid plasma clearance, escape into interstitial water (22%ID at 20 min), significant early urinary excretion (8%ID in 12 h), and prompt deposition in liver and skeleton (complete in 12 h) are evidence of inefficient binding to plasma protein of newly injected Pu(IV) in mice. Slow plasma clearance, little early urinary excretion, and delayed deposition in liver and skeleton reflect more efficient binding of newly injected Pu(IV) in Reference Man and dog. 39 refs., 6 figs., 3 tabs.

  18. Nevirapine ( NVP ) and Protease Inhibitor ( PI ) Based Regimens in a Directly Observed Therapy ( DOT ) Program for Intravenous Drug Users ( IDUs )

    Microsoft Academic Search

    Brian Conway; Jennie Prasad; Nadine Smith; Stanley de Vlaming

    Background of study: The treatment of HIV-infected IDUs presents unique challenges, including co-infection with agents such as HCV, interaction with drugs such as methadone, and the use of strategies used to enhance adherence with often complex highly active antiretroviral therapy (HAART) regimens. Within the context of a methadone maintenance program for heroin users, we have established a directly observed therapy

  19. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials

    Microsoft Academic Search

    Ellen C Keeley; Judith A Boura; Cindy L Grines

    2003-01-01

    Summary Background Many trials have been done to compare primary percutaneous transluminal coronary angioplasty (PTCA) with thrombolytic therapy for acute ST-segment elevation myocardial infarction (AMI). Our aim was to look at the combined results of these trials and to ascertain which reperfusion therapy is most effective. Methods We did a search of published work and identified 23 trials, which together

  20. Combination Therapy with Antibiotics and Anthrax Immune Globulin Intravenous (AIGIV) Is Potentially More Effective than Antibiotics Alone in Rabbit Model of Inhalational Anthrax

    PubMed Central

    Kammanadiminti, Srinivas; Patnaikuni, Ravi Kumar; Comer, Jason; Meister, Gabriel; Sinclair, Chris; Kodihalli, Shantha

    2014-01-01

    Background We have evaluated the therapeutic efficacy of AIGIV when given in combination with levofloxacin and the effective window of treatment to assess the added benefit provided by AIGIV over standard antibiotic treatment alone in a New Zealand white rabbit model of inhalational anthrax. Methods Rabbits were exposed to lethal dose of aerosolized spores of Bacillus anthracis (Ames strain) and treated intravenously with either placebo, (normal immune globulin intravenous, IGIV) or 15 U/kg of AIGIV, along with oral levofloxacin treatment at various time points (30–96 hours) after anthrax exposure. Results The majority of treated animals (>88%) survived in both treatment groups when treatment was initiated within 60 hours of post-exposure. However, reduced survival of 55%, 33% and 25% was observed for placebo + levofloxacin group when the treatment was initiated at 72, 84 and 96 hours post-exposure, respectively. Conversely, a survival rate of 65%, 40% and 71% was observed in the AIGIV + levofloxacin treated groups at these time points. Conclusions The combination of AIGIV with antibiotics provided an improvement in survival compared to levofloxacin treatment alone when treatment was delayed up to 96 hours post-anthrax exposure. Additionally, AIGIV treatment when given as an adjunct therapy at any of the time points tested did not interfere with the efficacy of levofloxacin. PMID:25226075

  1. Intravenous Regional Anesthesia Using Lidocaine and Ketorolac

    Microsoft Academic Search

    Scott S. Reuben; Robert B. Steinberg; Joel M. Kreitzer; Karen M. Duprat

    1996-01-01

    Nonsteroidal antiinflammatory drugs (NSAIDs) inter- fere with the synthesis of inflammatory mediators and can supplement postoperative pain relief. We postu- lated that using the parenterally available NSAID ketorolac (K) as a component of intravenous regional anesthesia (IVRA) would suppress intraoperative tour- niquet pain and enhance postoperative analgesia. Sixty patients were assigned randomly and blindly to receive either intravenous (IV) saline

  2. Implications to payers of switch from hospital-based intravenous immunoglobulin to home-based subcutaneous immunoglobulin therapy in patients with primary and secondary immunodeficiencies in Canada

    PubMed Central

    2014-01-01

    Background Switching primary/secondary immunodeficiency (PID/SID) patients from intravenous immunoglobulin (IVIg) to home-based subcutaneous immunoglobulin (SCIg) therapy reduces nurse time. A nurse shortage in Canada provides an important context to estimate the net economic benefit, the number of patients needed to switch to SCIg to recoup one full-time equivalent (FTE), and potential population-wide savings of reduced nurse time to a payer. Methods The net economic benefit was estimated by multiplying the hourly compensation for nurses in Canada by the hours required for each administration route. The number needed to switch to SCIg to gain one nurse FTE was estimated by dividing the work hours in a year by the average annual savings in nursing time in a PID population in Canada. The prevalence of treated PID/SID in Canada was calculated using provincial IgG audit data to extrapolate the potential population-wide savings of switching patients to SCIg therapy. Findings The net economic gain from switching one patient to home-based SCIg care would be C$2,603 (Canadian Dollars) in year 1 and C$2,948 each year thereafter. Switching 37 IVIg patients to SCIg would gain one nurse FTE. Switching 50% of the estimated 5,486 PID and SID patients in Canada receiving IVIg therapy to SCIg has the potential to save 223.3 nurse FTEs (C$23.2 million in labor costs). Conclusions A shift from IVIg to less labor-intensive SCIg has the potential to help alleviate nurse shortages and reduce overall health care costs in Canada. Health care professionals might consider advocating for home-based SCIg therapy for PID/SID patients when clinically appropriate. PMID:24872821

  3. Safety of Intravenous Application of Mistletoe (Viscum album L.) Preparations in Oncology: An Observational Study

    PubMed Central

    Steele, Megan L.; Axtner, Jan; Happe, Antje; Kröz, Matthias; Matthes, Harald; Schad, Friedemann

    2014-01-01

    Background. Traditional mistletoe therapy in cancer patients involves subcutaneous applications of Viscum album L. preparations, with doses slowly increasing based on patient responses. Intravenous infusion of high doses may improve therapeutic outcomes and is becoming more common. Little is known about the safety of this “off-label” application of mistletoe. Methods. An observational study was performed within the Network Oncology. Treatment with intravenous mistletoe applications is described. The frequency of adverse drug reactions (ADRs) to intravenous mistletoe applications was calculated and compared to ADR data from a study on subcutaneous applications. Results. Of 475 cancer patients who received intravenous infusions of Helixor, Abnoba viscum, or Iscador mistletoe preparations, 22 patients (4.6%) reported 32 ADRs of mild (59.4%) or moderate severity (40.6%). No serious ADRs occurred. ADRs were more frequently reported to i.v. mistletoe administered alone (4.3%), versus prior to chemotherapy (1.6%). ADR frequency differed with respect to preparation type, with Iscador preparations showing a higher relative frequency, compared to Abnoba viscum and Helixor. Overall, patients were almost two times less likely to experience an ADR to intravenous compared to subcutaneous application of mistletoe. Conclusion. Intravenous mistletoe therapy was found to be safe and prospective studies for efficacy are recommended. PMID:24955100

  4. Safety of Intravenous Application of Mistletoe (Viscum album L.) Preparations in Oncology: An Observational Study.

    PubMed

    Steele, Megan L; Axtner, Jan; Happe, Antje; Kröz, Matthias; Matthes, Harald; Schad, Friedemann

    2014-01-01

    Background. Traditional mistletoe therapy in cancer patients involves subcutaneous applications of Viscum album L. preparations, with doses slowly increasing based on patient responses. Intravenous infusion of high doses may improve therapeutic outcomes and is becoming more common. Little is known about the safety of this "off-label" application of mistletoe. Methods. An observational study was performed within the Network Oncology. Treatment with intravenous mistletoe applications is described. The frequency of adverse drug reactions (ADRs) to intravenous mistletoe applications was calculated and compared to ADR data from a study on subcutaneous applications. Results. Of 475 cancer patients who received intravenous infusions of Helixor, Abnoba viscum, or Iscador mistletoe preparations, 22 patients (4.6%) reported 32 ADRs of mild (59.4%) or moderate severity (40.6%). No serious ADRs occurred. ADRs were more frequently reported to i.v. mistletoe administered alone (4.3%), versus prior to chemotherapy (1.6%). ADR frequency differed with respect to preparation type, with Iscador preparations showing a higher relative frequency, compared to Abnoba viscum and Helixor. Overall, patients were almost two times less likely to experience an ADR to intravenous compared to subcutaneous application of mistletoe. Conclusion. Intravenous mistletoe therapy was found to be safe and prospective studies for efficacy are recommended. PMID:24955100

  5. Reversal of hypercalcemic acute kidney injury by treatment with intravenous bisphosphonates

    Microsoft Academic Search

    Ari Auron; Leyat Tal; Tarak Srivastava; Uri S. Alon

    2009-01-01

    We present the details of three children with hypercalcemia-induced acute kidney injury (AKI). After traditional therapy with\\u000a fluids, loop diuretics, steroids and calcitonin had failed to correct the hypercalcemia, they were given treatment with low\\u000a doses of intravenous (i.v.) pamidronate, which resulted in normalization of serum calcium and kidney function. In one child\\u000a Doppler renal ultrasound revealed dampened arterial blood

  6. Patient Outcomes on Day 4 of Intravenous Antibiotic Therapy in Non–Intensive Care Unit Hospitalized Adults With Community-Acquired Bacterial Pneumonia

    PubMed Central

    Robinson, Scott B.; Ernst, Frank R.; Lipkin, Craig; Huang, Xingyue

    2014-01-01

    Background Community-acquired bacterial pneumonia (CABP) is a leading cause of morbidity and mortality especially in hospitalized patients. In place of clinical end points traditionally used to evaluate antimicrobial efficacy for its treatment, Food and Drug Administration guidelines now require all registration trials to assess clinical response at day 4. The primary objective of this study was to assess health outcomes (length of stay [LOS] and hospital charges) between responders and nonresponders at this time point. Methods The Premier database was used to identify adult patients from 4 participating hospitals with a principal diagnosis of CABP (International Classification of Diseases, Ninth Revision, Clinical Modification, codes 481, 482.0, 483.8, 484.3, 484.5, 485, 486, or 487.0) hospitalized between July 1, 2010, and June 30, 2011. Only non–intensive care unit patients with hospital stays exceeding 2 days and receiving intravenous antibiotic agents within 24 hours of admission were included. After institutional review board approvals, a retrospective chart review extracted data for patient demographics, clinical efficacy variables at day 4, LOS, and total hospital charges. Data analysis included multivariable gamma regression models to control for patient demographics and clinical differences between responders and nonresponders. Results A total of 666 patients met study the criteria. Mean (SD) age was 70.7 (17.9) years, and 42.5% were males. Among these patients, 277 (41.6%) achieved clinical response by day 4 of initial antibiotic therapy. The unadjusted mean (SD) LOS was 6.3 (2.8) days for responders and 7.4 (5.6) days for nonresponders (P = 0.0009). Respective unadjusted total hospital charges were $22,827 (SD, $17,724) and $26,403 ($36,882) (P = 0.0031). Adjusted for demographics and clinical factors, nonresponders compared with responders had an increased LOS of 0.9 days (8.4 vs 7.5 days; P = 0.0008), resulting in associated charges of approximately $2500 ($34,139 vs $36,629; P = 0.0768). Conclusions In this real-world chart study, less than half of hospitalized patients with CABP achieved clinical response at day 4 of initial intravenous antibiotic therapy. The observed clinical response was associated with a significantly shorter hospital stay and trended toward lower total hospital charges. These findings corroborate the Food and Drug Administration guidance for assessing antimicrobial therapy at day 4 because responder is associated with improved health outcomes. PMID:25411532

  7. Intracoronary thallium-201 scintigraphy after thrombolytic therapy for acute myocardial infarction compared with 10 and 100 day intravenous thallium-201 scintigraphy

    SciTech Connect

    Heller, G.V.; Parker, J.A.; Silverman, K.J.; Royal, H.D.; Kolodny, G.M.; Paulin, S.; Braunwald, E.; Markis, J.E.

    1987-02-01

    Thallium-201 imaging has been utilized to estimate myocardial salvage after thrombolytic therapy for acute myocardial infarction. However, results from recent animal studies have suggested that as a result of reactive hyperemia and delayed necrosis, thallium-201 imaging may overestimate myocardial salvage. To determine whether early overestimation of salvage occurs in humans, intracoronary thallium-201 scans 1 hour after thrombolytic therapy were compared with intravenous thallium-201 scans obtained approximately 10 and 100 days after myocardial infarction in 29 patients. In 10 patients with angiographic evidence of coronary reperfusion, immediate improvement in thallium defects and no interim clinical events, there was no change in imaging in the follow-up studies. Of nine patients with coronary reperfusion but no initial improvement of perfusion defects, none showed worsening of defects in the follow-up images. Six of these patients demonstrated subsequent improvement at either 10 or 100 days after infarction. Seven of 10 patients with neither early evidence of reperfusion nor improvement in perfusion defects had improvement of infarct-related perfusion defects, and none showed worsening. In conclusion, serial scanning at 10 and 100 days after infarction in patients with no subsequent clinical events showed no worsening of the perfusion image compared with images obtained in acute studies. Therefore, there is no evidence that thallium-201 imaging performed early in patients with acute myocardial infarction overestimates improvement.

  8. Characterization of intravenous medication administration in an intensive care unit

    E-print Network

    Thorn, Catherine A. (Catherine Ann), 1980-

    2004-01-01

    This project focuses on characterizing intravenous (IV) medication administration in an intensive care unit at a partner hospital. Information regarding IV medication dose was extracted from MIMIC II, a large database ...

  9. Intravenous Chemotherapy or Oral Chemotherapy in Treating Patients With Previously Untreated Stage III-IV HIV-Associated Non-Hodgkin Lymphoma

    ClinicalTrials.gov

    2014-10-28

    AIDS-related Diffuse Large Cell Lymphoma; AIDS-related Diffuse Mixed Cell Lymphoma; AIDS-related Diffuse Small Cleaved Cell Lymphoma; AIDS-related Immunoblastic Large Cell Lymphoma; AIDS-related Lymphoblastic Lymphoma; AIDS-related Peripheral/Systemic Lymphoma; AIDS-related Small Noncleaved Cell Lymphoma; Stage III AIDS-related Lymphoma; Stage IV AIDS-related Lymphoma

  10. Intravenous Fluid Generation System

    NASA Technical Reports Server (NTRS)

    McQuillen, John; McKay, Terri; Brown, Daniel; Zoldak, John

    2013-01-01

    The ability to stabilize and treat patients on exploration missions will depend on access to needed consumables. Intravenous (IV) fluids have been identified as required consumables. A review of the Space Medicine Exploration Medical Condition List (SMEMCL) lists over 400 medical conditions that could present and require treatment during ISS missions. The Intravenous Fluid Generation System (IVGEN) technology provides the scalable capability to generate IV fluids from indigenous water supplies. It meets USP (U.S. Pharmacopeia) standards. This capability was performed using potable water from the ISS; water from more extreme environments would need preconditioning. The key advantage is the ability to filter mass and volume, providing the equivalent amount of IV fluid: this is critical for remote operations or resource- poor environments. The IVGEN technology purifies drinking water, mixes it with salt, and transfers it to a suitable bag to deliver a sterile normal saline solution. Operational constraints such as mass limitations and lack of refrigeration may limit the type and volume of such fluids that can be carried onboard the spacecraft. In addition, most medical fluids have a shelf life that is shorter than some mission durations. Consequently, the objective of the IVGEN experiment was to develop, design, and validate the necessary methodology to purify spacecraft potable water into a normal saline solution, thus reducing the amount of IV fluids that are included in the launch manifest. As currently conceived, an IVGEN system for a space exploration mission would consist of an accumulator, a purifier, a mixing assembly, a salt bag, and a sterile bag. The accumulator is used to transfer a measured amount of drinking water from the spacecraft to the purifier. The purifier uses filters to separate any air bubbles that may have gotten trapped during the drinking water transfer from flowing through a high-quality deionizing cartridge that removes the impurities in the water before entering the salt bag and mixing with the salt to create a normal saline solution.

  11. Interstitial photodynamic therapy in subcutaneously implanted urologic tumors in rats after intravenous administration of 5-aminolevulinic acid

    Microsoft Academic Search

    Zhengwen Xiao; Yahya Tamimi; Kevin Brown; John Tulip; Ronald Moore

    2002-01-01

    Photodynamic therapy (PDT) may be an attractive option for treatment of early stage prostate cancer. Aminolevulinic acid (ALA) acts as a pro-drug leading to a selective accumulation of a photosensitizer, protoporphyrin IX (PpIX), in epithelial cells. We investigated the efficacy of ALA-mediated PDT for rat R3327-H prostate cancer, compared with the AY-27 bladder tumor. Rats bearing either AY-27 or R3327-H

  12. Intracerebral hemorrhage secondary to intravenous and endovascular intraarterial revascularization therapies in acute ischemic stroke: an update on risk factors, predictors, and management.

    PubMed

    Mokin, Maxim; Kan, Peter; Kass-Hout, Tareq; Abla, Adib A; Dumont, Travis M; Snyder, Kenneth V; Hopkins, L Nelson; Siddiqui, Adnan H; Levy, Elad I

    2012-04-01

    Intracerebral hemorrhage (ICH) secondary to intravenous and intraarterial revascularization strategies for emergent treatment of acute ischemic stroke is associated with high mortality. ICH from systemic thrombolysis typically occurs within the first 24-36 hours of treatment initiation and is characterized by rapid hematoma development and growth. Pathophysiological mechanisms of revascularization therapy-induced ICH are complex and involve a combination of several distinct processes, including the direct effect of thrombolytic agents, disruption of the blood-brain barrier secondary to ischemia, and direct vessel damage from wire and microcatheter manipulations during endovascular procedures. Several definitions of ICH secondary to thrombolysis currently exist, depending on clinical or radiological characteristics used. Multiple studies have investigated clinical and laboratory risk factors associated with higher rates of ICH in this setting. Early ischemic changes seen on noncontrast CT scanning are strongly associated with higher rates of hemorrhage. Modern imaging techniques, particularly CT perfusion, provide rapid assessment of hemodynamic parameters of the brain. Specific patterns of CT perfusion maps can help identify patients who are likely to benefit from revascularization or to develop hemorrhagic complications. There are no established guidelines that describe management of revascularization therapy-induced ICH, and great variability in treatment protocols currently exist. General principles that apply to the management of spontaneous ICH might not be as effective for revascularization therapy-induced ICH. In this article, the authors review current knowledge of risk factors and radiological predictors of ICH secondary to stroke revascularization techniques and analyze medical and surgical management strategies for ICH in this setting. PMID:22463112

  13. Effects of intravenous human umbilical cord blood CD34+ stem cell therapy versus levodopa in experimentally induced Parkinsonism in mice

    PubMed Central

    Abo-Grisha, Noha; Abo-Elmatty, Dina M.; Abdel-Hady, Zenab

    2013-01-01

    Introduction Parkinsonism is a neurodegenerative disease with impaired motor function. The current research was directed to investigate the effect of CD34+ stem cells versus levodopa in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced Parkinsonism. Material and methods Mice were divided into 4 groups; saline-injected, MPTP: received four MPTP injections (20 mg/kg, i.p.) at 2 h intervals, MPTP groups treated with levodopa/carbidopa (100/10 mg/kg/twice/day for 28 days) or single intravenous injection of 106 CD34+ stem cells/mouse at day 7 and allowed to survive until the end of week 5. Results Levodopa and stem cells improved MPTP-induced motor deficits; they abolished the difference in stride length, decreased percentage of foot slip errors and increased ambulation, activity factor and mobility duration in parkinsonian mice (p < 0.05). Further, they significantly (p < 0.05) increased striatal dopamine (85.3 ±4.3 and 110.6 ±5.3) and ATP levels (10.6 ±1.1 and 15.5 ±1.14) compared to MPTP (60.1 ±3.9 pmol/g and 3.6 ±0.09 mmol/g, respectively) (p < 0.05). Moreover, mitochondrial DNA from mice treated with levodopa or stem cells was in intact form; average concentration was (52.8 ±3.01 and 107.8 ±8.6) and no appreciable fragmentation of nuclear DNA was found compared to MPTP group. Regarding tyrosine hydroxylase (TH) immunostaining, stem cell group showed a marked increase of percentage of TH-immunopositive neurons (63.55 ±5.2) compared to both MPTP (37.6 ±3.1) and levodopa groups (41.6 ±3.5). Conclusions CD34+ cells ameliorated motor, biochemical and histological deficits in MPTP-parkinsonian mice, these effects were superior to those produced by levodopa that would be promising for the treatment of PD. PMID:24482663

  14. Intravenous iron replacement therapy in eugonadal males with iron-deficiency anemia: Effects on pituitary gonadal axis and sperm parameters; A pilot study

    PubMed Central

    Soliman, Ashraf; Yassin, Mohamed; De Sanctis, Vincenzo

    2014-01-01

    Aim of the study: To evaluate semen parameters and to assess serum FSH, LH, Testosterone (T) concentrations before and 12 weeks after intravenous iron therapy (800-1200 mg elemental iron therapy - IVI) in adults with iron-deficiency anemia (IDA). Materials and Methods: We studied 11 eugonadal adults with IDA, aged 40 ± 5 years, due to defective intake of iron. Anemia was diagnosed when hemoglobin (Hb) was equal or below 10 g/dl. Serum iron, total iron-binding capacity (TIBC) and ferritin concentrations confirmed the diagnosis of IDA. Basal serum concentrations of FSH, LH, and T were measured. Semen parameters were evaluated before and 6-7 weeks after IVI therapy. Results: After IVI therapy and correction of anemia, a significant increase of Hb from 8.1 ± 1.17 g/dL to 13.1 ± 0.7 g/dL was observed and was associated with an increase of T (from 12.22 ± 1.4 nmol/L to 15.9 ± 0.96 nmol/L; P < 0.001), FSH (from 2.82 ± 0.87 to 3.82 ± 1.08 IU/L; P = 0.007), and LH (from 2.27 ± 0.9 to 3.82 ± 1.5 IU/L; P = 0.0002). Total sperm count (TSC) increased significantly from 72 ± 17.5 million/ml to 158 ± 49 million/mL (P < 0.001), rapid progressive sperm motility (RPM) increased from 22 ± 9.4 to 69 ± 30 million/ml (P < 0.001), and sperms with normal morphology (NM) increased from 33 ± 5 to 56 ± 7 million/ml (P < 0.001). Increment in Hb concentration was correlated significantly with LH, FSH, and T concentrations after IVI (r = 0.69 and r = 0.44, r = 0.75, respectively; P < 0.01). The increment in serum T was correlated significantly with increments in the TSC and total sperm motility and RPM (r = 0.66, 0.43, and 0.55, respectively; P < 0.001) but not with gonadotrophin levels. Conclusion: Our study proved for the first time, to our knowledge, that correction of IDA with IVI is associated with significant enhancement of sperm parameters and increased concentrations of serum LH, FSH, and T. These effects on spermatogenesis are reached by an unknown mechanism and suggest a number of pathways that need further human and/or experimental studies. PMID:24944924

  15. The effect of combination therapy with rituximab and intravenous immunoglobulin on the progression of chronic antibody mediated rejection in renal transplant recipients.

    PubMed

    An, Gun Hee; Yun, Jintak; Hong, Yu Ah; Khvan, Marina; Chung, Byung Ha; Choi, Bum Soon; Park, Cheol Whee; Choi, Yeong Jin; Kim, Yong-Soo; Yang, Chul Woo

    2014-01-01

    The treatment for chronic active antibody-mediated rejection (CAMR) remains controversial. We investigated the efficacy of rituximab (RTX) and intravenous immunoglobulin (IVIg) for CAMR. Eighteen patients with CAMR were treated with RTX (375?mg/m(2)) and IVIg (0.4?g/kg) for 4 days. The efficacy of RTX/IVIg combination therapy (RIT) was assessed by decline in estimated glomerular filtration rate per month (?eGFR) before and after RIT. Patients were divided into responder and nonresponder groups based on decrease and no decrease in ?eGFR, respectively, and their clinical and histological characteristics were compared. Response rate to RIT was 66.7% (12/18), and overall ?eGFR decreased significantly to 0.4 ± 1.7?mL·min(-1) ·1.73?m(-2) per month 6 months after RIT compared to that observed 6 months before RIT (1.8 ± 1.0, P < 0.05). Clinical and histological features between the 12 responders and the 6 nonresponders were not significantly different, but nonresponders had a significantly higher proteinuria levels at the time of RIT (2.5 ± 2.5 versus 7.0 ± 3.5 protein/creatinine (g/g), P < 0.001). The effect of the RIT on ?eGFR had dissipated in all patients by 1 year post-RIT. Thus, RIT delayed CAMR progression, and baseline proteinuria level was a prognostic factor for response to RIT. PMID:24741626

  16. [Long-term control of stage IV breast and gastric cancer with combination therapy of S-1 and paclitaxel].

    PubMed

    Yamada, Chizu; Ishikawa, Fumihiko; Nitta, Hiroshi; Fujita, Yoshihisa; Omoto, Hideyuki; Kamata, Shigeyuki; Ito, Hiroshi

    2014-11-01

    We here describe a case of Stage IV breast and gastric cancer in which S-1/paclitaxel therapy was effective in maintaining the patient's QOL. A 50-year-old woman visited our hospital with complaints of her right breast tumor and right brachialgia. She was diagnosed with breast cancer with multiple bone metastases including cervical vertebrae. Accordingly, local radiation therapy and tamoxifen(TAM)administration was started immediately. Gastrointestinal endoscopy revealed gastric cancer, but laparotomy disclosed the gastric cancer was unresectable. At that time, the complaints of pain, nausea, and fatigue had increased and S-1/paclitaxel therapy was started immediately. The treatment reduced the size of the lesions in the breast and stomach and improved the QOL without serious adverse events. We have been maintaining partial response(PR)in this patient for 28 months. PMID:25731389

  17. Vaccine Therapy in Treating Patients With Stage IIC-IV Melanoma

    ClinicalTrials.gov

    2014-05-20

    Ciliary Body and Choroid Melanoma, Medium/Large Size; Ciliary Body and Choroid Melanoma, Small Size; Extraocular Extension Melanoma; Iris Melanoma; Metastatic Intraocular Melanoma; Mucosal Melanoma; Recurrent Intraocular Melanoma; Recurrent Melanoma; Stage IIC Melanoma; Stage IIIA Intraocular Melanoma; Stage IIIA Melanoma; Stage IIIB Intraocular Melanoma; Stage IIIB Melanoma; Stage IIIC Intraocular Melanoma; Stage IIIC Melanoma; Stage IV Intraocular Melanoma; Stage IV Melanoma

  18. In Vivo Transduction by Intravenous Injection of a Lentiviral Vector Expressing Human ADA into Neonatal ADA Gene Knockout Mice: A Novel Form of Enzyme Replacement Therapy for ADA Deficiency

    Microsoft Academic Search

    Denise A. Carbonaro; Xiangyang Jin; Denise Petersen; Xingchao Wang; Fred Dorey; Ki Soo Kil; Melissa Aldrich; Michael R. Blackburn; Rodney E. Kellems; Donald B. Kohn

    2006-01-01

    Using a mouse model of adenosine deaminase–deficient severe combined immune deficiency syndrome (ADA-deficient SCID), we have developed a noninvasive method of gene transfer for the sustained systemic expression of human ADA as enzyme replacement therapy. The method of delivery is a human immunodeficiency virus 1–based lentiviral vector given systemically by intravenous injection on day 1 to 2 of life. In

  19. Intravenous Thrombolytics for Ischemic Stroke

    Microsoft Academic Search

    Andrew D. Barreto

    For many decades, intravenous (IV) thrombolytics have been delivered to treat acute thrombosis. Although these medications\\u000a were originally effective for coronary thrombosis, their mechanisms have proven beneficial for many other disease processes,\\u000a including ischemic stroke. Treatment paradigms for acute ischemic stroke have largely followed those of cardiology. Specifically,\\u000a the aim has been to recanalize the occluded artery and to restore

  20. Establish a perioperative check forum for peripheral intravenous access to prevent the occurrence of phlebitis.

    PubMed

    Chiu, Po-Chun; Lee, Ya-Hui; Hsu, Hung-Te; Feng, Yu-Tung; Lu, I-Cheng; Chiu, Shun-Li; Cheng, Kuang-I

    2015-04-01

    The prevalence of intravenous (IV) catheter-related infections is 0.5 per 1000 device days, and these infections cause tenderness, erythema, swelling and phlebitis. Catheter-related bloodstream infections (CRBSI) may independently increase hospital costs and length of stay; the aim of the study was to set up a standard operating procedure (SOP) for the maintenance of peripheral vein catheter patency and the prevention of IV catheter-related complications. This is a retrospective study, enrolling patients who received anesthesia between April 2010 and January 2011. The study included 1 month of pretest phase, and 3 months each of "notification" phase, "observation" phase and "end" phase, respectively. The cannulations were set up by surgical ward nurses following the SOP on establishing peripheral intravenous catheter in our hospital. The cannulation sites were then examined before surgery and postoperatively by registered nurse anesthetists using the Baxter Scale. We also tried to set up a feedback circuit to let ward nurses know about the IV patency rate. As a result, 14,682 patients were enrolled in the study. The incidence of IV therapy-related adverse events was 0.78% in the notification phase, 0.43% in the observation phase, and 0.13% in the end phase. Overall IV therapy-related events declined significantly (p < 0.01), and the presence of phlebitis was associated with age (p < 0.05). An SOP established to assess IV patency through a checklist can reduce phlebitis and improve quality. The checklist increases ward nurses' and nurse anesthetists' awareness of IV patency, and the feedback circuit substantially reduces IV event rate. PMID:25835279

  1. A clinical study on drug-related problems associated with intravenous drug administration

    PubMed Central

    Vijayakumar, A.; Sharon, E. V.; Teena, J.; Nobil, S.; Nazeer, I.

    2014-01-01

    Background: Infusion therapy through intravenous (IV) access is a therapeutic option used in the treatment of many hospitalized patients. IV therapy is complex, potentially dangerous and error prone. The objectives were to ascertain the drug-related problems (DRPs) involved in IV medication administration and further to develop strategies to reduce and prevent the occurrence of DRPs during IV administration. Materials and Methods: A prospective observational study was carried out for a period of 4 months. Patients receiving more than two medications through IV route were included and studied. Results: Of 110 patients, 76 (69.09%) were male and the rest were female. Nearly, half of the patients (46.3%, n = 51) were reported with DRPs. Of the 80 DRPs (72.72%) documented, 61 problems (55.4%) were seen in patients given IV medications through peripheral line. Among the DRPs majority seen were incompatibilities (40.9%, n = 45), followed by complications developed (12.7%, n = 14), errors in rate of administration (10.9%), and dilution errors (8%). To study the association of DRPs among gender, statistical analysis was performed and significant association was seen between DRPs and gender (P = 0.03). Conclusion: Among the reported DRPs, simultaneous IV administration of two incompatible drugs was the main predicament faced. PMID:25031500

  2. Is DTPA a good competing chelating agent for Th(IV) in human serum and suitable in targeted alpha therapy?

    PubMed

    Le Du, Alicia; Sabatié-Gogova, Andrea; Morgenstern, Alfred; Montavon, Gilles

    2012-04-01

    The interaction between thorium and human serum components was studied using difference ultraviolet spectroscopy (DUS), ultrafiltration and high-pressure-anion exchange chromatography (HPAEC) with external inductively conducted plasma mass spectrometry (ICP-MS) analysis. Experimental data are compared with modelling results based on the law of mass action. Human serum transferrin (HSTF) interacts strongly with Th(IV), forming a ternary complex including two synergistic carbonate anions. This complex governs Th(IV) speciation under blood serum conditions. Considering the generally used Langmuir-type model, values of 10(33.5) and 10(32.5) were obtained for strong and weak sites, respectively. We showed that trace amounts of diethylene triamine pentaacetic acid (DTPA) cannot complex Th(IV) in the blood serum at equilibrium. Unexpectedly this effect is not related to the competition with HSTF but is due to the strong competition with major divalent metal ions for DTPA. However, Th-DTPA complex was shown to be stable for a few hours when it is formed before addition in the biological medium; this is related to the high kinetic stability of the complex. This makes DTPA a potential chelating agent for synthesis of (226)Th-labelled biomolecules for application in targeted alpha therapy. PMID:22388013

  3. Intravenous iron in inflammatory bowel disease

    PubMed Central

    Muñoz, Manuel; Gómez-Ramírez, Susana; García-Erce, José Antonio

    2009-01-01

    The prevalence of anemia across studies on patients with inflammatory bowel disease (IBD) is high (30%). Both iron deficiency (ID) and anemia of chronic disease contribute most to the development of anemia in IBD. The prevalence of ID is even higher (45%). Anemia and ID negatively impact the patient’s quality of life. Therefore, together with an adequate control of disease activity, iron replacement therapy should start as soon as anemia or ID is detected to attain a normal hemoglobin (Hb) and iron status. Many patients will respond to oral iron, but compliance may be poor, whereas intravenous (IV) compounds are safe, provide a faster Hb increase and iron store repletion, and presents a lower rate of treatment discontinuation. Absolute indications for IV iron treatment should include severe anemia, intolerance or inappropriate response to oral iron, severe intestinal disease activity, or use of an erythropoietic stimulating agent. Four different products are principally used in clinical practice, which differ in their pharmacokinetic properties and safety profiles: iron gluconate and iron sucrose (lower single doses), and iron dextran and ferric carboxymaltose (higher single doses). After the initial resolution of anemia and the repletion of iron stores, the patient’s hematological and iron parameters should be carefully and periodically monitored, and maintenance iron treatment should be provided as required. New IV preparations that allow for giving 1000-1500 mg in a single session, thus facilitating patient management, provide an excellent tool to prevent or treat anemia and ID in this patient population, which in turn avoids allogeneic blood transfusion and improves their quality of life. PMID:19787830

  4. Intravenous iron for the treatment of predialysis anemia.

    PubMed

    Silverberg, D S; Blum, M; Agbaria, Z; Schwartz, D; Zubkov, A; Yachnin, T; Iaina, A

    1999-03-01

    This article, based on our own studies and those of others, presents evidence to show that the anemia of chronic renal failure in the predialysis period is, to a significant extent, caused by iron deficiency and can be improved in most cases by the administration of intravenous (i.v.) but not oral iron. We estimate that in approximately 30% of all predialysis patients with anemia, a target hematocrit (Hct) of 35% can be reached and maintained by giving i.v. iron alone without exceeding currently acceptable limits of serum ferritin (500 microg/liter) or the percentage of iron saturation (40%). If, in addition, subcutaneous erythropoietin (EPO-usually in only low doses-is added, the combination has an additive effect on the Hct response, and almost all anemic predialysis patients can reach and maintain the target Hct of 35% over a one-year period. Therefore, the advantage of maintaining adequate iron stores with i.v. iron is that if EPO is needed, lower doses will be required to achieve the target Hct than if EPO were used alone. This not only avoids the high cost of EPO therapy but also its associated side-effects, especially hypertension. Using Venofer, a ferric hydroxide sucrose complex, as our i.v. iron supplement, we have seen no anaphylactic reactions in over 20,000 infusions over a four-year period in 360 hemodialysis, 123 predialysis, and 58 peritoneal dialysis patients. PMID:10084291

  5. Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency†

    PubMed Central

    Ponikowski, Piotr; van Veldhuisen, Dirk J.; Comin-Colet, Josep; Ertl, Georg; Komajda, Michel; Mareev, Viacheslav; McDonagh, Theresa; Parkhomenko, Alexander; Tavazzi, Luigi; Levesque, Victoria; Mori, Claudio; Roubert, Bernard; Filippatos, Gerasimos; Ruschitzka, Frank; Anker, Stefan D.

    2015-01-01

    Aim The aim of this study was to evaluate the benefits and safety of long-term i.v. iron therapy in iron-deficient patients with heart failure (HF). Methods and results CONFIRM-HF was a multi-centre, double-blind, placebo-controlled trial that enrolled 304 ambulatory symptomatic HF patients with left ventricular ejection fraction ?45%, elevated natriuretic peptides, and iron deficiency (ferritin <100 ng/mL or 100–300 ng/mL if transferrin saturation <20%). Patients were randomized 1 : 1 to treatment with i.v. iron, as ferric carboxymaltose (FCM, n = 152) or placebo (saline, n = 152) for 52 weeks. The primary end-point was the change in 6-min-walk-test (6MWT) distance from baseline to Week 24. Secondary end-points included changes in New York Heart Association (NYHA) class, Patient Global Assessment (PGA), 6MWT distance, health-related quality of life (QoL), Fatigue Score at Weeks 6, 12, 24, 36, and 52 and the effect of FCM on the rate of hospitalization for worsening HF. Treatment with FCM significantly prolonged 6MWT distance at Week 24 (difference FCM vs. placebo: 33 ± 11 m, P = 0.002). The treatment effect of FCM was consistent in all subgroups and was sustained to Week 52 (difference FCM vs. placebo: 36 ± 11 m, P < 0.001). Throughout the study, an improvement in NYHA class, PGA, QoL, and Fatigue Score in patients treated with FCM was detected with statistical significance observed from Week 24 onwards. Treatment with FCM was associated with a significant reduction in the risk of hospitalizations for worsening HF [hazard ratio (95% confidence interval): 0.39 (0.19–0.82), P = 0.009]. The number of deaths (FCM: 12, placebo: 14 deaths) and the incidence of adverse events were comparable between both groups. Conclusion Treatment of symptomatic, iron-deficient HF patients with FCM over a 1-year period resulted in sustainable improvement in functional capacity, symptoms, and QoL and may be associated with risk reduction of hospitalization for worsening HF (ClinicalTrials.gov number NCT01453608). PMID:25176939

  6. A Phase II, Open-Label Study of Ramucirumab in Combination with Paclitaxel and Carboplatin as First-Line Therapy in Patients with Stage IIIB/IV Non–Small-Cell Lung Cancer

    PubMed Central

    Berge, Eamon M.; Doebele, Robert C.; Ballas, Marc S.; Jahan, Thierry; Haigentz, Missak; Hoffman, David; Spicer, James; West, Howard; Lee, Pablo; Yang, Ling; Joshi, Adarsh; Gao, Ling; Yurasov, Sergey; Mita, Alain

    2014-01-01

    Introduction: The objective of this study was to determine whether the addition of ramucirumab to first-line paclitaxel–carboplatin chemotherapy in patients with advanced non–small-cell lung cancer (NSCLC) resulted in a 6-month progression-free survival (PFS) rate that compares favorably with the historic rate for bevacizumab combined with paclitaxel–carboplatin in this patient population. Methods: In this phase II, single-arm, open-label, multicenter study, 40 patients with advanced NSCLC received ramucirumab (10 mg/kg intravenous [IV]) followed by paclitaxel (200 mg/m2 IV) and carboplatin area under the curve = 6 on day 1 every 21 days as first-line therapy. Therapy continued for up to six cycles. Patients not experiencing withdrawal criteria may have continued ramucirumab monotherapy every 3 weeks. The primary endpoint was PFS at 6 months, with 80% power to detect a 6-month PFS rate of at least 55%. Results: The 6-month PFS rate was 59.0% and the objective response rate was 55.0%. The most common treatment-related adverse events were fatigue, peripheral neuropathy, nausea, epistaxis, and myalgia. Single-nucleotide polymorphism (SNP) rs2981582 on the FGFR-2gene had significant associations with improved overall survival, PFS, and best overall response (p values without multiplicity adjustment were 0.0059, 0.0429, and 0.0392, respectively). Conclusion: Ramucirumab in combination with paclitaxel–carboplatin resulted in a 6-month PFS rate and safety profile that compared favorably with the historical control. In addition, no deaths were associated with this treatment. Furthermore, we describe an association of SNP on FGFR-2 gene with survival and response. These findings warrant further clinical investigation in patients with NSCLC. PMID:25170639

  7. Hypofractionated Image Guided Radiation Therapy in Treating Patients With Stage IV Breast Cancer

    ClinicalTrials.gov

    2014-03-11

    Central Nervous System Metastases; Invasive Ductal Breast Carcinoma; Invasive Ductal Breast Carcinoma With Predominant Intraductal Component; Invasive Lobular Breast Carcinoma; Invasive Lobular Breast Carcinoma With Predominant in Situ Component; Liver Metastases; Lobular Breast Carcinoma in Situ; Lung Metastases; Male Breast Cancer; Medullary Ductal Breast Carcinoma With Lymphocytic Infiltrate; Mucinous Ductal Breast Carcinoma; Papillary Ductal Breast Carcinoma; Recurrent Breast Cancer; Stage IV Breast Cancer; Tubular Ductal Breast Carcinoma; Tumors Metastatic to Brain

  8. Phosphodiesterase IV inhibitors as therapy for eosinophil-induced lung injury in asthma.

    PubMed Central

    Torphy, T J; Barnette, M S; Hay, D W; Underwood, D C

    1994-01-01

    Asthma is a complex, multifactorial disease that is underpinned by airway inflammation. A variety of cytotoxic substances are released into the airway from infiltrating inflammatory cells, especially the eosinophil. These cytotoxic substances, including reactive oxygen metabolites, produce damage to the airway epithelium, a histologic feature of chronic asthma. Damage to the airway epithelium, in turn, is thought to be a major factor responsible for the development of airway hyperreactivity, a hallmark of asthma. One notable molecular target for novel antiasthmatic drugs is the cyclic AMP-specific phosphodiesterase (PDE) or PDE IV. This isozyme is the predominant form of cyclic nucleotide PDE activity in inflammatory cells. Thus, in view of the putative role of cyclic AMP as an inhibitory second messenger in these cells, PDE IV inhibitors have been shown to suppress inflammatory cell activity. The purpose of the present experiments was to examine the effect of the PDE IV inhibitor, R-rolipram, on three key functions of the guinea pig eosinophil: a) superoxide anion (O2-) production, b) adhesion to human umbilical vein endothelial cells (HUVECs), and c) infiltration into the airway. R-rolipram-elevated eosinophil cyclic AMP content (EC50 = 1.7 microM) and inhibited fMLP-induced O2- production in a concentration-dependent manner (IC50 = 0.3 microM). In contrast, neither siguazodan, a PDE III inhibitor, nor zaprinast, a PDE V inhibitor, had an appreciable effect. R-rolipram (30 microM) also reduced by 25 to 40% the adhesion of eosinophils to HUVECs stimulated with phorbol myristate acetate or tumor necrosis factor-alpha, particularly under conditions in which both cell types were simultaneously exposed to the PDE IV inhibitor.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7705312

  9. Phase I Study of Intravenous Triapine (IND # 68338) in Combination With Pelvic Radiation Therapy With or Without Weekly Intravenous Cisplatin Chemotherapy for Locally Advanced Cervical, Vaginal, or Pelvic Gynecologic Malignancies

    ClinicalTrials.gov

    2013-01-10

    Recurrent Cervical Cancer; Recurrent Ovarian Epithelial Cancer; Recurrent Vaginal Cancer; Recurrent Vulvar Cancer; Stage III Vaginal Cancer; Stage IIIA Cervical Cancer; Stage IIIA Ovarian Epithelial Cancer; Stage IIIA Vulvar Cancer; Stage IIIB Cervical Cancer; Stage IIIB Ovarian Epithelial Cancer; Stage IIIB Vulvar Cancer; Stage IIIC Ovarian Epithelial Cancer; Stage IIIC Vulvar Cancer; Stage IV Ovarian Epithelial Cancer; Stage IVA Cervical Cancer; Stage IVA Vaginal Cancer; Stage IVB Cervical Cancer; Stage IVB Vaginal Cancer

  10. A Phase I study of weekly intravenous oxaliplatin in combination with oral daily capecitabine and radiation therapy in the neoadjuvant treatment of rectal adenocarcinoma

    SciTech Connect

    Fakih, Marwan G. [Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (United States) and Department of Pharmacology and Experimental Therapeutics, Roswell Park Cancer Institute, Buffalo, NY (United States)]. E-mail: marwan.fakih@roswellpark.org; Rajput, Ashwani [Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY (United States); Department of Pharmacology and Experimental Therapeutics, Roswell Park Cancer Institute, Buffalo, NY (United States); Yang, Gary Y. [Department of Radiation Oncology, Roswell Park Cancer Institute, Buffalo, NY (United States); Pendyala, Lakshmi [Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (United States); Toth, Karoly [Department of Pharmacology and Experimental Therapeutics, Roswell Park Cancer Institute, Buffalo, NY (United States); Smith, Judy L. [Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY (United States); Lawrence, David D. [Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY (United States); Rustum, Youcef M. [Department of Pharmacology and Experimental Therapeutics, Roswell Park Cancer Institute, Buffalo, NY (United States)

    2006-08-01

    Purpose: We conducted a Phase I study to determine the maximum tolerated dose (MTD) of neoadjuvant capecitabine, oxaliplatin, and radiation therapy (RT) in Stage II to III rectal adenocarcinoma. Methods and Materials: Capecitabine was given orally twice daily Monday through Friday concurrently with RT. Oxaliplatin was given i.v. once weekly x 5 (for 5 weeks) starting the first day of RT. RT was given daily except on weekends and holidays at 1.8 Gy per fraction x 28. Escalation for capecitabine or oxaliplatin was to occur in cohorts of three patients until the maximum tolerated dose (MTD) was defined. Endorectal tumor biopsy samples were obtained before and on Day 3 of treatment to explore the effects of treatment on thymidine phosphorylase, thymidylate synthase, dihydropyrimidine dehydrogenase, DNA repair, and apoptosis. Results: Twelve patients were enrolled on this study. Two of 6 patients at dose level (DL) 1 (capecitabine 825 mg/m{sup 2} orally (p.o.) given twice daily (b.i.d.); oxaliplatin 50 mg/m{sup 2}/week) had a dose-limiting diarrhea. One of 6 patients at DL (-)1 (capecitabine 725 mg/m{sup 2} p.o., b.i.d.; oxaliplatin 50 mg/m{sup 2}/week) experienced-dose-limiting diarrhea. Three of 11 patients who underwent resection had a complete pathologic response. No remarkable variations in rectal tumor biologic endpoints were noted on Day 3 of treatment in comparison to baseline. However, a higher apotosis index was observed at baseline and on Day 3 in complete pathologic responders (no statistical analysis performed). Conclusions: Capecitabine 725 mg/m{sup 2} p.o., twice daily in combination with oxaliplatin 50 mg/m{sup 2}/week and RT 50.4 Gy in 28 fractions is the recommended dose for future studies.

  11. Feasibility study of Californium-252 for the therapy of stage IV cervical cancer.

    PubMed

    Maruyama, Y; Van Nagell, J R; Yoneda, J; Donaldson, E; Gallion, H; Patel, P; Kryscio, R J

    1988-06-15

    Twenty patients with Stage IVA and IVB cervic cancers were treated with Californium-252 (Cf) neutron brachytherapy (NT) in a feasibility trial between 1976 and 1986. Eleven patients had Stage IVA disease; nine patients had Stage IVB disease. Patient compliance with therapy was poor in four of nine patients with Stage IVB disease, and the 50% survival time was 6 months. In Stage IVA disease there were 18% 3-year survivals. For those that failed, the 50% survival time was 7.5 months. Because of the frequency of disseminated metastases, effective adjuvant therapy needs to be developed to use after the tumor debulking therapy, especially for Stage IVB disease. A single early Cf-NT implant followed by 6000 cGy of whole-pelvis fractionated radiation would accomplish this adequately for local tumor control and palliation. PMID:3130179

  12. Once Daily i.v. Busulfan and Fludarabine (i.v. Bu-Flu) Compares Favorably with i.v. Busulfan and Cyclophosphamide (i.v. BuCy2) as Pretransplant Conditioning Therapy in AML\\/MDS

    Microsoft Academic Search

    Borje S. Andersson; Marcos de Lima; Peter F. Thall; Xuemei Wang; Daniel Couriel; Martin Korbling; Soonja Roberson; Sergio Giralt; Betty Pierre; James A. Russell; Elizabeth J. Shpall; Roy B. Jones; Richard E. Champlin

    2008-01-01

    We postulated that fludarabine (Flu) instead of cyclophosphamide (Cy) combined with i.v. busulfan (Bu) as preconditioning for allogeneic hematopoietic stem cell transplantation (HSCT) would improve safety and retain antileukemic efficacy. Sixty-seven patients received BuCy2, and subsequently, 148 patients received Bu-Flu. We used a Bayesian method to compare outcomes between these nonrandomized patients. The groups had comparable pretreatment characteristics, except that

  13. Cetuximab and Radiation Therapy in Treating Patients With Stage III-IV Head and Neck Cancer

    ClinicalTrials.gov

    2014-06-26

    Stage III Squamous Cell Carcinoma of the Hypopharynx; Stage III Squamous Cell Carcinoma of the Larynx; Stage III Squamous Cell Carcinoma of the Oropharynx; Stage III Verrucous Carcinoma of the Larynx; Stage IV Squamous Cell Carcinoma of the Hypopharynx; Stage IVA Squamous Cell Carcinoma of the Larynx; Stage IVA Squamous Cell Carcinoma of the Oropharynx; Stage IVA Verrucous Carcinoma of the Larynx; Stage IVB Squamous Cell Carcinoma of the Larynx; Stage IVB Squamous Cell Carcinoma of the Oropharynx; Stage IVB Verrucous Carcinoma of the Larynx; Tongue Cancer

  14. Hyperbaric oxygen therapy in BKV-associated hemorrhagic cystitis refractory to intravenous and intravesical cidofovir: Case report and review of literature

    Microsoft Academic Search

    Daniele Focosi; Fabrizio Maggi; Donatella Pistolesi; Edoardo Benedetti; Federico Papineschi; Sara Galimberti; Luca Ceccherini-Nelli; Mario Petrini

    2009-01-01

    Hemorrhagic cystitis is a common complication in hematopoietic stem cell transplant recipients. We report here a case of severe BKV-associated hemorrhagic cystitis who did not respond to intravenous cidofovir. Overt hematuria successfully resolved after a few days on hyperbaric oxygen and intravesical instillations of cidofovir, while BK viruria dropped after a few weeks and remained low. We review the literature

  15. Intravenous Rattlesnake Envenomation

    PubMed Central

    Davidson, Terence M.

    1988-01-01

    Intravenous envenomation by North American rattlesnakes is an uncommon occurrence, but a true emergency. In three documented, successfully resuscitated cases, the mainstay of treatment was the immediate intravenous administration of antivenin. PMID:3341134

  16. Treatment of acute pandysautonomia with intravenous immunoglobulin.

    PubMed Central

    Mericle, R A; Triggs, W J

    1997-01-01

    Acute pandysautonomia has been suggested to be an uncommon variant of Guillain-Barre syndrome. Acute pandysautonomia does not seem to have been treated with intravenous immunoglobulin or other therapies proved efficacious in Guillain-Barre syndrome. A patient is reported with severe acute pandysautonomia who responded dramatically to intravenous immunoglobulin. The findings are consistent with a dysimmune pathogenesis for this syndrome and suggest a possible treatment for future cases. PMID:9153616

  17. Oral gemifloxacin once daily for 5 days compared with sequential therapy with i.v. ceftriaxone\\/oral cefuroxime (maximum of 10 days) in the treatment of hospitalized patients with acute exacerbations of chronic bronchitis

    Microsoft Academic Search

    R. WILSON; C. LANGAN; P. BALL; K. BATEMAN; R. PYPSTRA

    2003-01-01

    In a randomized, open-label, controlled, multicentre study, the clinical and bacteriological efficacy, safety and tolerability of oral gemifloxacin (320 mg once daily, 5 days) was compared with sequential intravenous (i.v.) ceftriaxone (1 g once daily, maximum 3 days) followed by oral cefuroxime axetil (500 mg twice daily, maximum 7 days) in adult hospitalized patients with acute exacerbations of chronic bronchitis

  18. Effects of switching from oral administration to intravenous injection of l-carnitine on lipid metabolism in hemodialysis patients

    PubMed Central

    Fukami, Kei; Yamagishi, Sho-ichi; Sakai, Kazuko; Nasu, Makoto; Okuda, Seiya

    2014-01-01

    Background Carnitine deficiency may contribute to cardiovascular disease (CVD) in patients with hemodialysis (HD). Dyslipidemia plays a role in CVD and its prevalence is also high in HD patients. We examined here the effects of switching from oral administration (PO) to intravenous (IV) injection of l-carnitine on lipid metabolism in patients with HD. Methods Nine HD patients who had received l-carnitine orally (900 mg/day) for 1 year were enrolled in this study. We examined whether lipid parameters were improved by switching to IV injection therapy of 1000 mg l-carnitine. Results IV injection of l-carnitine for 1 week significantly increased total, free and acyl carnitine levels both before and after HD. Switching to IV injection therapy for 1 and 4 weeks decreased serum free fatty acid (FFA) (322 ± 104 versus 261 ± 124 µmol/L) and increased high-density lipoprotein-cholesterol levels (1.46 ± 0.49 versus 1.63 ± 0.62 mmol/L), respectively. Change in FFA values from the baseline (?FFA) was positively correlated with the ?acyl/free carnitine ratio (r2 = 0.553, P = 0.022). Conclusion This study demonstrated that switching to IV l-carnitine therapy from oral supplementation improved lipid profiles, thus supporting the clinical utility of IV administration of l-carnitine for the treatment of patients on HD. PMID:25878778

  19. Intravenously administered nanoparticles increase survival following blast trauma

    PubMed Central

    Lashof-Sullivan, Margaret M.; Shoffstall, Erin; Atkins, Kristyn T.; Keane, Nickolas; Bir, Cynthia; VandeVord, Pamela; Lavik, Erin B.

    2014-01-01

    Explosions account for 79% of combat-related injuries, leading to multiorgan hemorrhage and uncontrolled bleeding. Uncontrolled bleeding is the leading cause of death in battlefield traumas as well as in civilian life. We need to stop the bleeding quickly to save lives, but, shockingly, there are no treatments to stop internal bleeding. A therapy that halts bleeding in a site-specific manner and is safe, stable at room temperature, and easily administered is critical for the advancement of trauma care. To address this need, we have developed hemostatic nanoparticles that are administered intravenously. When tested in a model of blast trauma with multiorgan hemorrhaging, i.v. administration of the hemostatic nanoparticles led to a significant improvement in survival over the short term (1 h postblast). No complications from this treatment were apparent out to 3 wk. This work demonstrates that these particles have the potential to save lives and fundamentally change trauma care. PMID:24982180

  20. Oral gemifloxacin versus sequential therapy with intravenous ceftriaxone\\/oral cefuroxime with or without a macrolide in the treatment of patients hospitalized with community-acquired pneumonia: A randomized, open-label, multicenter study of clinical efficacy and tolerability

    Microsoft Academic Search

    Hartmut Lode; Thomas M File; Lionel Mandell; Peter Ball; Rienk Pypstra; Michael Thomas

    2002-01-01

    Objective: This study aimed to compare the efficacy and safety of oral gemifloxacin, an enhanced-affinity quinolone, with sequential therapy with IV ceftriaxone followed by oral cefuroxime (with or without a macrolide) in patients hospitalized for community-acquired pneumonia (CAP).Methods: A randomized, open-label, multicenter study comprised adults hospitalized with a clinical and radiologic diagnosis of CAP. Patients were randomized 1:1 to receive

  1. Use and abuse of intravenous solutions.

    PubMed

    Vidt, D G

    1975-05-01

    Recent microbial infusion disasters underline the fact that infusions carry a substantial risk of morbidity and mortality. Those who make a habit of setting up an intravenous infusion as a convenient route for the administration of drugs, or just in case it may be needed later, would do well to review their methodsmthe increased probability of contamination and subsequent patient infection by the practice of adding drugs to intravenous fluids is not generally recognized. To reduce the possibility of microbial contamination, the open system with tube containers should be opened only in an aseptic environment, eg, a laminar flow hood, to allow the vacuum to be replace by aseptic air; the open-system containers should be opened only in an aseptic environment, and a bacterial filter should be inserted in the air entry port of the closure. Routine monitoring of intravenous solutions for microbial contamination should be standard procedure for any institution providing intravenous fluid therapy to patientsmthe following recommendations are suggested for consideration by hospital pharmacy and therapeutics committees: 1, The addition of drugs to intravenous fluids should be discouraged except in recognized cases of emergency. 2 when the addition of drugs to intravenous fluids is indicated, only one drug should be added to an intravenous fluid, and the only intravenous fluids used for this purpose should be isotonic saline or 5% dextrose solution in water. More complicated electrolyte solutions and protein hydrolysate solutions should never be used for additive purposes. Guidelines should be established in hospitals for the addition of drugs to intravenous fluids. These guidelines should be followed by trained personnel who have access to all available compatibility data. Additions should be made under aseptic conditions by trained personnel, preferably in the hospital pharmacy. 4. All additions of drugs should be included in the patient's permanent drug file, and the intravenous container should be clearly labeled before administration. 5. Critical attention should be directed to the administration equipment used for intravenous solutions, particularly volume control sets. Consideration should be given to the routine use of terminal in-line millipore filters to prevent the infusion of particulate matter and to minimize microbial contamination. In emergency situations when it is necessary to add drugs to an intravenous fluid by the bedside, the addition should be made in accordance with established hospital procedure and should be subject to periodic monitoring. Each hospital pharmacy and therapeutics committee should give serious consideration to the establishment of a continuous admixture monitoring system and quality control program. Such a program will provide valuable information regarding sources of contamination rates and will provide invaluable information in planning in-service education and training programs pertaining to intravenous therapy preparation and administration. PMID:804572

  2. A pilot randomised controlled trial of negative pressure wound therapy to treat grade III/IV pressure ulcers [ISRCTN69032034

    PubMed Central

    2012-01-01

    Background Negative pressure wound therapy (NPWT) is widely promoted as a treatment for full thickness wounds; however, there is a lack of high-quality research evidence regarding its clinical and cost effectiveness. A trial of NPWT for the treatment of grade III/IV pressure ulcers would be worthwhile but premature without assessing whether such a trial is feasible. The aim of this pilot randomised controlled trial was to assess the feasibility of conducting a future full trial of NPWT for the treatment of grade III and IV pressure ulcers and to pilot all aspects of the trial. Methods This was a two-centre (acute and community), pilot randomised controlled trial. Eligible participants were randomised to receive either NPWT or standard care (SC) (spun hydrocolloid, alginate or foam dressings). Outcome measures were time to healing of the reference pressure ulcer, recruitment rates, frequency of treatment visits, resources used and duration of follow-up. Results Three hundred and twelve patients were screened for eligibility into this trial over a 12-month recruitment period and 12/312 participants (3.8%) were randomised: 6 to NPWT and 6 to SC. Only one reference pressure ulcer healed (NPWT group) during follow-up (time to healing 79?days). The mean number of treatment visits per week was 3.1 (NPWT) and 5.7 (SC); 6/6 NPWT and 1/6 SC participants withdrew from their allocated trial treatment. The mean duration of follow-up was 3.8 (NPWT) and 5.0 (SC) months. Conclusions This pilot trial yielded vital information for the planning of a future full study including projected recruitment rate, required duration of follow-up and extent of research nurse support required. Data were also used to inform the cost-effectiveness and value of information analyses, which were conducted alongside the pilot trial. Trial registration Current Controlled Trials ISRCTN69032034. PMID:22839453

  3. The dipeptidyl peptidase IV inhibitor NVP-DPP728 reduces plasma glucagon concentration in cats.

    PubMed

    Furrer, Daniela; Kaufmann, Karin; Tschuor, Flurin; Reusch, Claudia E; Lutz, Thomas A

    2010-03-01

    Glucagon-like peptide-1 (GLP-1) analogues and inhibitors of its degrading enzyme, dipeptidyl peptidase IV (DPPIV), are interesting therapy options in human diabetics because they increase insulin secretion and reduce postprandial glucagon secretion. Given the similar pathophysiology of human type 2 and feline diabetes mellitus, this study investigated whether the DPPIV inhibitor NVP-DPP728 reduces plasma glucagon levels in cats. Intravenous glucose tolerance tests (ivGTT; 0.5 g/kg glucose after 12 h fasting) and a meal response test (test meal of 50% of average daily food intake, offered after 24 h fasting) were performed in healthy experimental cats. NVP-DPP728 (0.5-2.5 mg/kg i.v. or s.c.) significantly reduced glucagon output in all tests and increased insulin output in the ivGTT. Follow-up studies will investigate the potential usefulness as therapy in diabetic cats. PMID:19128990

  4. Long-term outcomes in patients with ambulatory new york heart association class III and IV heart failure undergoing cardiac resynchronization therapy.

    PubMed

    Rickard, John; Bassiouny, Mohammed; Tedford, Ryan J; Baranowski, Bryan; Spragg, David; Cantillon, Daniel; Varma, Niraj; Wilkoff, Bruce L; Tang, W H Wilson

    2015-01-01

    Patients with ambulatory New York Heart Association (NYHA) class IV heart failure were significantly underrepresented in clinical trials of cardiac resynchronization therapy (CRT). The natural long-term trajectory of survival free of left ventricular assist device (LVAD) or heart transplant in patients with ambulatory class IV symptoms who underwent CRT has not been established. We extracted clinical data on 723 consecutive patients with NYHA class III or ambulatory class IV heart failure, left ventricular ejection fraction ?35%, and a QRS duration ?120 ms who underwent CRT from September 30, 2003, to August 6, 2007. Chart notes immediately before CRT were reviewed to confirm NYHA class status before CRT. Kaplan-Meier curves and a multivariate Cox proportional hazards model were constructed to determine long-term survival free of heart transplant and LVAD based on NYHA class status. Of the 723 patients, 52 had ambulatory class IV symptoms. Over a mean follow-up of 5.0 ± 2.5 years controlling for many possible confounders, ambulatory NYHA class IV status was independently associated with poor long-term outcomes. The 1-, 2-, 3-, 4-, and 5-year survival free of LVAD or heart transplant for class III versus ambulatory class IV patients was 92.0%, 84.0%, 75.0%, 68.1%, and 63.2% versus 75.0%, 61.5%, 52.0%, 45%, and 40.4%, respectively. Although patients with ambulatory class IV heart failure receiving CRT have inferior long-term outcomes compared with those with class III symptoms, survival in class IV patients continues to parallel class III patients over an extended follow-up. At 5 years, survival free of LVAD or heart transplant in ambulatory class IV patients receiving CRT is 40%. PMID:25491007

  5. Erlotinib Hydrochloride and Radiation Therapy in Stage III-IV Squamous Cell Cancer of the Head and Neck

    ClinicalTrials.gov

    2012-10-30

    Stage III Squamous Cell Carcinoma of the Hypopharynx; Stage III Squamous Cell Carcinoma of the Larynx; Stage III Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage III Squamous Cell Carcinoma of the Oropharynx; Stage III Verrucous Carcinoma of the Larynx; Stage III Verrucous Carcinoma of the Oral Cavity; Stage IV Squamous Cell Carcinoma of the Hypopharynx; Stage IV Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage IV Squamous Cell Carcinoma of the Nasopharynx; Stage IV Squamous Cell Carcinoma of the Oropharynx; Stage IV Verrucous Carcinoma of the Larynx; Stage IV Verrucous Carcinoma of the Oral Cavity

  6. The dipeptidyl peptidase IV inhibitor NVP-DPP728 reduces plasma glucagon concentration in cats

    Microsoft Academic Search

    Daniela Furrer; Karin Kaufmann; Flurin Tschuor; Claudia E. Reusch; Thomas A. Lutz

    2010-01-01

    Glucagon-like peptide-1 (GLP-1) analogues and inhibitors of its degrading enzyme, dipeptidyl peptidase IV (DPPIV), are interesting therapy options in human diabetics because they increase insulin secretion and reduce postprandial glucagon secretion. Given the similar pathophysiology of human type 2 and feline diabetes mellitus, this study investigated whether the DPPIV inhibitor NVP-DPP728 reduces plasma glucagon levels in cats. Intravenous glucose tolerance

  7. Oral\\/intravenous maintenance dosing of valproate following intravenous loading: a simulation

    Microsoft Academic Search

    Sandeep Dutta; James C Cloyd; G. Richard Granneman; Stephen D Collins

    2003-01-01

    Valproic acid (VPA) has a narrow therapeutic range (50–100mg\\/l) and exhibits nonlinear protein binding. Additionally, VPA pharmacokinetics are dependent on age, induction status, and formulation; so titration and dosing vary between individuals. The aim of these simulations was to determine optimal intravenous (i.v.) loading dose, and i.v. and oral VPA maintenance regimens. A 5-min 15mg\\/kg loading dose resulted in total

  8. Effects of intravenous methylnaltrexone on opioid-induced gut motility and transit time changes in subjects receiving chronic methadone therapy: a pilot study.

    PubMed

    Yuan, C S; Foss, J F; O'Connor, M; Osinski, J; Roizen, M F; Moss, J

    1999-12-01

    In this preliminary study, we evaluated the effects of methylnaltrexone, a peripheral opioid-receptor antagonist, on chronic opioid-induced gut motility and transit changes in four subjects with chronic methadone-induced constipation. Subjects participated in this single blind, placebo controlled study for up to 8 days. We gave placebo the first day; for the remainder of the study, we gave intravenous methylnaltrexone (0.05-0.45 mg/kg) twice daily. During the study period, we recorded oral-cecal transit time and opioid withdrawal symptoms, as well as laxation response based on the frequency and consistency of the stools. Subjects 1 and 2 who were administered methylnaltrexone 0.45 mg/kg, a dose previously administered in normal volunteers, showed immediate positive laxation. Subject 2, after positive laxation response, had severe abdominal cramping, but showed no opioid systemic signs of withdrawal. The subject was discontinued due to the cramping. In Subjects 3 and 4, we reduced the methylnaltrexone dose to 0.05-0.15 mg/kg. The latter two subjects also had an immediate laxation response during and after intravenous medication without significant side effects. The stool frequency of these four subjects increased from 1-2 times per week before the study to approximately 1.5 stool per day during the treatment period. Oral-cecal transit times of Subjects 1, 3, and 4 were reduced from 150, 150 and 150 min (after placebo) to 90, 60 and 60 min (with methylnaltrexone), respectively. Our preliminary results demonstrate that low dose intravenous methylnaltrexone effectively reversed chronic methadone-induced constipation and delay in gut transit time. Thus, we anticipate that cancer patients receiving chronic opioids may also have increased sensitivity to methylnaltrexone, and that low dose methylnaltrexone may have clinical utility in managing opioid-induced constipation in chronic-pain patients. PMID:10568873

  9. Lidocaine priming reduces tourniquet pain during intravenous regional anesthesia: A preliminary study

    Microsoft Academic Search

    Jean-Pierre Estèbe; Marc E. Gentili; Grégoire Langlois; Philippe Mouilleron; Franck Bernard; Claude Ecoffey

    2003-01-01

    Background and Objectives: Tourniquet pain often limits the use of intravenous regional anesthesia (IVRA). Intravenous (IV) lidocaine has been shown to be effective in the management of acute and neuropathic pains. We tested the hypothesis that a priming IV injection of lidocaine might have an analgesic effect on tourniquet pain during IVRA. Methods: A prospective, randomized, double- blind study was

  10. Phase 3 Trial of Postoperative Chemotherapy Alone Versus Chemoradiation Therapy in Stage III-IV Gastric Cancer Treated With R0 Gastrectomy and D2 Lymph Node Dissection

    SciTech Connect

    Kim, Tae Hyun; Park, Sook Ryun; Ryu, Keun Won; Kim, Young-Woo [Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of)] [Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Bae, Jae-Moon [Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)] [Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Lee, Jun Ho; Choi, Il Ju; Kim, Yeon-Joo [Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of)] [Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Kim, Dae Yong, E-mail: radiopiakim@hanmail.net [Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of)

    2012-12-01

    Purpose: To compare chemotherapy alone with chemoradiation therapy in stage III-IV(M0) gastric cancer treated with R0 gastrectomy and D2 lymph node dissection. Methods and Materials: The chemotherapy arm received 5 cycles of fluorouracil and leucovorin (FL), and the chemoradiation therapy arm received 1 cycle of FL, then radiation therapy of 45 Gy concurrently with 2 cycles of FL, followed by 2 cycles of FL. Intent-to-treat analysis and per-protocol analyses were performed. Results: Between May 6, 2002 and June 29, 2006, a total of 90 patients were enrolled. Forty-four were randomly assigned to the chemotherapy arm and 46 to the chemoradiation therapy arm. Treatment was completed as planned by 93.2% of patients in the chemotherapy arm and 87.0% in the chemoradiation therapy arm. Overall intent-to-treat analysis showed that addition of radiation therapy to chemotherapy significantly improved locoregional recurrence-free survival (LRRFS) but not disease-free survival. In subgroup analysis for stage III, chemoradiation therapy significantly prolonged the 5-year LRRFS and disease-free survival rates compared with chemotherapy (93.2% vs 66.8%, P=.014; 73.5% vs 54.6%, P=.056, respectively). Conclusions: Addition of radiation therapy to chemotherapy could improve the LRRFS in stage III gastric cancer treated with R0 gastrectomy and D2 lymph node dissection.

  11. Medicolegal considerations with intravenous tissue plasminogen activator in stroke: a systematic review.

    PubMed

    Bhatt, Archit; Safdar, Adnan; Chaudhari, Dhara; Clark, Diane; Pollak, Amber; Majid, Arshad; Kassab, Mounzer

    2013-01-01

    Background. Intravenous tPA (tissue plasminogen activator) therapy remains underutilized in patients with Acute Ischemic Stroke (AIS). Anecdotal data indicates that physicians are increasingly liable for administering and for failure to administer tPA. Methods. An extensive search of Medline, Embase, Westlaw, LexisNexis Legal, and Google Scholar databases was performed. Case studies that involved malpractice litigation in ischemic stroke and thrombolytic therapy were analyzed systematically. Results. We identified 789 ischemic stroke litigation cases, of which 46 cases were related to intravenous tPA and stroke litigation. Case descriptions of 40 cases were available. Data for verdicts were available for 38 patients. The most frequent plaintiff claim was related to failure to administer intravenous tPA (38, 95%). Only 2 (5.0%) claim involved complications of treatment with tPA. Hospitals were defendants in majority of the 36 cases. Physicians were involved in 33 cases. While ED physicians were involved in 25 (60.52%) cases, neurologists were involved in 8 (20.0%) cases. There were 26 (65%) defendant-favored and 12 (30%) plaintiff-favored verdicts. Conclusion. Physicians and hospitals are at an increased risk of litigation in patients with AIS when in IV-tPA is being considered for treatment. While majority of the cases litigated were cases where tPA was not administered, only about 1 in 20 cases was litigated when complications occurred. PMID:24083048

  12. Medicolegal Considerations with Intravenous Tissue Plasminogen Activator in Stroke: A Systematic Review

    PubMed Central

    Bhatt, Archit; Safdar, Adnan; Majid, Arshad; Kassab, Mounzer

    2013-01-01

    Background. Intravenous tPA (tissue plasminogen activator) therapy remains underutilized in patients with Acute Ischemic Stroke (AIS). Anecdotal data indicates that physicians are increasingly liable for administering and for failure to administer tPA. Methods. An extensive search of Medline, Embase, Westlaw, LexisNexis Legal, and Google Scholar databases was performed. Case studies that involved malpractice litigation in ischemic stroke and thrombolytic therapy were analyzed systematically. Results. We identified 789 ischemic stroke litigation cases, of which 46 cases were related to intravenous tPA and stroke litigation. Case descriptions of 40 cases were available. Data for verdicts were available for 38 patients. The most frequent plaintiff claim was related to failure to administer intravenous tPA (38, 95%). Only 2 (5.0%) claim involved complications of treatment with tPA. Hospitals were defendants in majority of the 36 cases. Physicians were involved in 33 cases. While ED physicians were involved in 25 (60.52%) cases, neurologists were involved in 8 (20.0%) cases. There were 26 (65%) defendant-favored and 12 (30%) plaintiff-favored verdicts. Conclusion. Physicians and hospitals are at an increased risk of litigation in patients with AIS when in IV-tPA is being considered for treatment. While majority of the cases litigated were cases where tPA was not administered, only about 1 in 20 cases was litigated when complications occurred. PMID:24083048

  13. Hypersensitivity from intravenous iron products.

    PubMed

    Bircher, Andreas J; Auerbach, Michael

    2014-08-01

    In the last several years, intravenous therapy with iron products has been more widely used. Although it has been a standard procedure in dialysis-associated anemia since the early 1990s, its use is expanding to a host of conditions associated with iron deficiency, especially young women with heavy uterine bleeding and pregnancy. Free iron is associated with unacceptable high toxicity inducing severe, hemodynamically significant symptoms. Subsequently, formulations that contain the iron as an iron carbohydrate nanoparticle have been designed. With newer formulations, including low-molecular-weight iron dextran, iron sucrose, ferric gluconate, ferumoxytol, iron isomaltoside, and ferric carboxymaltose, serious adverse events are rare. PMID:25017687

  14. Outcomes of early switching from intravenous to oral antibiotics on medical wards

    PubMed Central

    Mertz, Dominik; Koller, Michael; Haller, Patricia; Lampert, Markus L.; Plagge, Herbert; Hug, Balthasar; Koch, Gian; Battegay, Manuel; Flückiger, Ursula; Bassetti, Stefano

    2009-01-01

    Objectives To evaluate outcomes following implementation of a checklist with criteria for switching from intravenous (iv) to oral antibiotics on unselected patients on two general medical wards. Methods During a 12 month intervention study, a printed checklist of criteria for switching on the third day of iv treatment was placed in the medical charts. The decision to switch was left to the discretion of the attending physician. Outcome parameters of a 4 month control phase before intervention were compared with the equivalent 4 month period during the intervention phase to control for seasonal confounding (before–after study; April to July of 2006 and 2007, respectively): 250 episodes (215 patients) during the intervention period were compared with the control group of 176 episodes (162 patients). The main outcome measure was the duration of iv therapy. Additionally, safety, adherence to the checklist, reasons against switching patients and antibiotic cost were analysed during the whole year of the intervention (n = 698 episodes). Results In 38% (246/646) of episodes of continued iv antibiotic therapy, patients met all criteria for switching to oral antibiotics on the third day, and 151/246 (61.4%) were switched. The number of days of iv antibiotic treatment were reduced by 19% (95% confidence interval 9%–29%, P = 0.001; 6.0–5.0 days in median) with no increase in complications. The main reasons against switching were persisting fever (41%, n = 187) and absence of clinical improvement (41%, n = 185). Conclusions On general medical wards, a checklist with bedside criteria for switching to oral antibiotics can shorten the duration of iv therapy without any negative effect on treatment outcome. The criteria were successfully applied to all patients on the wards, independently of the indication (empirical or directed treatment), the type of (presumed) infection, the underlying disease or the group of antibiotics being used. PMID:19401304

  15. New iv induction anaesthetics

    Microsoft Academic Search

    D. H. Morison

    1993-01-01

    The history of intravenous (iv) anaesthetic induction agents almost mirrors that of the 50 years of the Canadian Anaesthetists' Society. ~ While other agents were available before its introduction, thiopentone has been used for slightly more than 50 yr. 2 In fact, Since its introduction, up until the present day, thiopentone has been considered as the standard against which other\\/v

  16. Intravenous regional anaesthesia

    Microsoft Academic Search

    Corinna M Matt

    2004-01-01

    Intravenous regional anaesthesia (IVRA) was first described by August Bier in 1908. He observed that when local anaesthetic was injected intravenously between two tourniquets on a limb, a rapid onset of anaesthesia occurred in the area between the tourniquets and a slower onset occurred beyond the distal tourniquet. The technique did not become popular until the 1960s when it was

  17. N-acetylcysteine treats intravenous amiodarone induced liver injury.

    PubMed

    Mudalel, Matthew L; Dave, Kartikeya P; Hummel, James P; Solga, Steven F

    2015-03-01

    We report a case of intravenous (IV) amiodarone drug induced liver injury (DILI). The patient received IV N-acetylcysteine (NAC) which resulted in a rapid improvement in liver enzymes. While the specific mechanisms for the pathogenesis of IV amiodarone DILI and the therapeutic action of IV NAC are both unknown, this case strongly implies at least some commonality. Because IV amiodarone is indicated for the treatment of serious cardiac arrhythmias in an intensive care unit setting, some degree of ischemic hepatitis is likely a cofactor in most cases. PMID:25759554

  18. N-acetylcysteine treats intravenous amiodarone induced liver injury

    PubMed Central

    Mudalel, Matthew L; Dave, Kartikeya P; Hummel, James P; Solga, Steven F

    2015-01-01

    We report a case of intravenous (IV) amiodarone drug induced liver injury (DILI). The patient received IV N-acetylcysteine (NAC) which resulted in a rapid improvement in liver enzymes. While the specific mechanisms for the pathogenesis of IV amiodarone DILI and the therapeutic action of IV NAC are both unknown, this case strongly implies at least some commonality. Because IV amiodarone is indicated for the treatment of serious cardiac arrhythmias in an intensive care unit setting, some degree of ischemic hepatitis is likely a cofactor in most cases. PMID:25759554

  19. Intravenous insulin use: technical aspects and caveats.

    PubMed

    Kalra, Sanjay; Bajwa, Sukhminder Jit Singh

    2013-05-01

    Insulin has been in use for nearly a century, but its real clinical worth has been utilized only in the last one and half decade after the landmark study on tight glycaemic control by van Den Berghe. Intravenous (i.v.) insulin is the mainstay of treatment for hyperglycaemia in many acute settings as well as in managing diabetic complications. However, i.v. insulin usage may be associated with numerous potential errors which may have unintended consequences. A thorough knowledge of various aspects associated with insulin injection techniques such as preparations of i.v. insulin, calculation of correct dosage, precautions while using insulin with various i.v. fluids, formulating strategies to minimize insulin adsorption to tubing surface, choosing appropriate insulin injection accessories and devices, can help in optimal control of hyperglycaemia with minimal errors. Improvisation of insulin injection techniques is often necessary in resource challenged settings to minimize the morbidity and mortality associated with uncontrolled hyperglycaemia. PMID:23758001

  20. A WOUND CARE AND INTRAVENOUS ACCESS SUMMIT FOR ON-ORBIT CARE

    NASA Technical Reports Server (NTRS)

    Scheuring, R.; Paul, B.; Gillis, D.; Bacal, K.; McCulley, P.; Polk, J.; Johnson-Throop, K.

    2005-01-01

    Wound care issues and the ability to establish intravenous (IV) access among injured or ill crew members are a source of concern for NASA flight surgeons. Indeed, the microgravity environment and the remote nature of the International Space Station (ISS) pose unique challenges in diagnosing and treating an injured astronaut. Therefore, it is necessary to identify and adapt the best evidence based terrestrial practices regarding wound care, hemostasis, and IV access for use on the ISS. Methods: A panel of consultants was convened to evaluate the adequacy of the current ISS in-flight medical system for diagnosis and treatment of wounds and establishing IV access by a nonclinician crew medical officer. Participants were acknowledged experts in terrestrial wound care and/or operational medicine. Prior to the meeting, each panelist was encouraged to participate in a pre-summit online forum. Results: Eight external experts participated in a face-to-face meeting held at NASA-Johnson Space Center. Recommendations were made to augment the space station pharmacopoeia, as well as current wound care diagnostic, therapeutic, and deorbit criteria protocols. Additionally, suggestions were offered regarding IV access techniques and devices for use in the microgravity environment. Discussion: The results of the expert panel provide an evidence-based approach to the diagnosis and care of wounds in an injured astronaut on aboard the ISS. The results of the panel underscored the need for further research in wound therapy and IV access devices.

  1. Intravenous volume tomographic pulmonary angiography imaging

    NASA Astrophysics Data System (ADS)

    Ning, Ruola; Strang, John G.; Chen, Biao; Conover, David L.; Yu, Rongfeng

    1999-05-01

    This study presents a new intravenous (IV) tomographic angiography imaging technique, called intravenous volume tomographic digital angiography (VTDA) for cross sectional pulmonary angiography. While the advantages of IV-VTDA over spiral CT in terms of volume scanning time and resolution have been validated and reported in our previous papers for head and neck vascular imaging, the superiority of IV-VTDA over spiral CT for cross sectional pulmonary angiography has not been explored yet. The purpose of this study is to demonstrate the advantage of isotropic resolution of IV-VTDA in the x, y and z directions through phantom and animal studies, and to explore its clinical application for detecting clots in pulmonary angiography. A prototype image intensifier-based VTDA imaging system has been designed and constructed by modifying a GE 8800 CT scanner. This system was used for a series of phantom and dog studies. A pulmonary vascular phantom was designed and constructed. The phantom was scanned using the prototype VTDA system for direct 3D reconstruction. Then the same phantom was scanned using a GE CT/i spiral CT scanner using the routine pulmonary CT angiography protocols. IV contrast injection and volume scanning protocols were developed during the dog studies. Both VTDA reconstructed images and spiral CT images of the specially designed phantom were analyzed and compared. The detectability of simulated vessels and clots was assessed as the function of iodine concentration levels, oriented angles, and diameters of the vessels and clots. A set of 3D VTDA reconstruction images of dog pulmonary arteries was obtained with different IV injection rates and isotropic resolution in the x, y and z directions. The results of clot detection studies in dog pulmonary arteries have also been shown. This study presents a new tomographic IV angiography imaging technique for cross sectional pulmonary angiography. The results of phantom and animal studies indicate that IV-VTDA is superior to spiral CT for cross sectional pulmonary angiography.

  2. 541?Intravenous Immunoglobulin in Leukocyte Adhesion Deficiency

    PubMed Central

    Oropeza, Said Arablin; Marco Antonio, Yamazaki-Nakashimada

    2012-01-01

    Background Leukocyte adhesion deficiency (LAD) is a primary immunodeficiency disease (PID) caused by a defect in neutrophil adhesion, characterized by skin ulcers, poor wound healing and recurrent bacterial infection. Intravenous immunoglobulin (IVIG) is used to treat patients with PID, but in LAD is not rutinely used. Treatment consists in prompt antibiotic, G-CSF for chronic ulcers and the only definite therapy is bone marrow transplantation (BMT). We present the case of a child with LAD, who was treated with IVIG with a good response before BMT. Methods We present a case report of a 2 year-old male, second child of consanguineous parents (cousins 1st grade). His sister had omphalitis and umbilical abscess and died at 6 months with candidiasis and perianal infection. There were 6 episodes of infectious diseases from birth to 6 months: At 11 days of life presented with omphalitis. At 2 months, upper respiratory tract infection with poor response to antibiotics. At 4 months he presented with suppurative otitis media, and was transferred to our hospital with suspected immunodeficiency, with neutrophilia (up to 95900). He was treated with IV antibiotics, and after resolution with prophylactic antibiotics. At 6 months had gastroenteritis and 1 week later septic shock. Treatment with intravenous immunoglobulins (IVIG) was started. Results After IVIG was initiated there were only 6 episodes of infectious diseases from 6 months to 2 years, including in the cord blood stem cell transplantation (CBSCT) period: at 9 months, gastroenteritis; at 15 months balanosposthitis (ecthyma gangrenosum), at 17 months had cellulitis in the hand and buttocks and oral candidiasis. CBSCT was performed on February 2011, at 1 year 11 months, but didn't engraft. He was discharged with prophylactic antibiotics and cyclosporine. At 2 years he had catheter associated sepsis. Currently the patient is receiving monthly IVIG, fluconazol, TMP SMX, Acyclovir and in protocol for BMT and has remained stable. Conclusions IVIG is not routinely used in LAD. In our case, monthly IVIG resulted in improvement with less infectious episodes. We suggest the use of IVIG as an adjuvant tool for the treatment of patients with LAD before BMT.

  3. Intravenous acetaminophen and intravenous ketorolac for management of pediatric surgical pain: a literature review.

    PubMed

    Baley, Kit; Michalov, Kara; Kossick, Mark A; McDowell, Mason

    2014-02-01

    Pediatric surgical patients are a population at risk of inadequate pain management. The American Society of Anesthesiologists' 2012 Practice Guidelines for Acute Pain Management in the Perioperative Setting recommend a multimodal approach as the most effective way to prevent and treat pain in children. A multimodal approach entails the use of 2 or more analgesic medications that act by different mechanisms, to maximally target a variety of pain receptors and reduce the potential for side effects. One method for incorporating a multimodal approach is to augment intravenous (IV) opioids with nonopioid IV analgesics. Ketorolac and acetaminophen are the 2 nonopioid IV analgesics currently available for use in the United States. This article provides a review of the literature of IV ketorolac and IV acetaminophen regarding their pharmacology, analgesic efficacy, limitations, and practical considerations, with a focus on patients 16 years of age and younger. PMID:24654353

  4. Severe hypophosphataemia after intravenous iron administration.

    PubMed

    Blazevic, A; Hunze, J; Boots, J M M

    2014-01-01

    Currently, in many centres, intravenous administration of iron is becoming increasingly popular because of higher efficacy and decreased side effects, mainly gastrointestinal, compared with oral iron therapy. Studies of intravenous ferric carboxymaltose administration in the postpartum setting and in patients with non-dialysis-dependent chronic kidney disease revealed a decrease in serum phosphate levels that was generally asymptomatic and transient. Here, we report four cases of severe and symptomatic hypophosphataemia after intravenous iron administration. All patients received this as therapy for iron deficiency anaemia due to heavy menstrual bleeding. In most cases, a pre-existent disorder in the phosphate homeostasis existed, such as a secondary (cases 3 and 4) or tertiary hyperparathyroidism (case 1). However, in the second case there were no risk factors for a dysregulation of the phosphate homeostasis. Based on these findings, we conclude that severe and symptomatic hypophosphatemia can occur as a side effect of intravenous iron administration and can persist for months after administration. Especially patients with low phosphate levels prior to therapy due to concomitant disorders in phosphate homeostasis (e.g. hyperparathyroidism, vitamin D deficiency) are at risk. PMID:24457442

  5. Use of intravenous rifampin in neonates with persistent staphylococcal bacteremia.

    PubMed Central

    Tan, T Q; Mason, E O; Ou, C N; Kaplan, S L

    1993-01-01

    Ten neonates with persistent staphylococcal bacteremia (positive blood cultures for > or = 5 days despite appropriate antibiotic therapy) received intravenous (i.v.) rifampin in combination with vancomycin with or without aminoglycoside. Their mean birth weight and length of gestation were 900 g and 27 weeks, respectively. Their ages at the time of infection ranged from 6 to 64 days (mean, 26 days). The staphylococcal isolates were methicillin-resistant Staphylococcus aureus (five isolates), methicillin-susceptible S. aureus (two isolates), and coagulase-negative staphylococci (three isolates). The mean number of bacteremia days prior to administration of i.v. rifampin was 8.3 (range, 5 to 15 days), despite a mean peak vancomycin concentration of 33 micrograms/ml. The dosing of rifampin varied from 2.5 to 10 mg/kg of body weight every 12 h. The mean duration of the rifampin course was 9.7 days (range, 3 to 16 days). Of the 10 neonates, 8 (80%) had sterile blood cultures within 24 h, 1 (10%) had a sterile blood culture within 48 h, and 1 (10%) had a sterile blood culture within 5 days of being placed on i.v. rifampin. No adverse effects were noted in this small group of infants. Seven of the 10 neonates survived; three died from unrelated complications. The MIC ranges of amikacin, vancomycin, and rifampin for the isolates were 2.0 to 16, 0.5 to 2.0, and 0.0013 to 0.04 micrograms/ml, respectively. We also studied eight infants, with a mean age of 23 days, who were receiving i.v. or oral rifampin at a dose of 10 mg/kg/day. For i.v. administration, the peak serum concentration of rifampin (mean +/- standard deviation) was 4.02 +/- 1.22 microgram/ml. The mean trough level at 12 h postifution was 1.11 +/- 0.48 micrograms/ml. For oral administration, the concentrations of rifampin in serum ranged from 0.59 to 2.86 micrograms/ml (mean, 1.86 +/- 0.96 microgram/ml) at 2 h postingestion, increasing to a peak concentration of 2.8 micrograms/ml at 8 h postingestion. The mean 12-h postingestion level was 0.77 +/- 0.03 microgram/ml. From the study of this limited series of neonates, rifampin appears to be a safe and effective addition to therapy when staphylococcal bacteremia is persistent despite vancomycin treatment. PMID:8285624

  6. Lack of evidence for intravenous vasodilators in ED patients with acute heart failure: a systematic review.

    PubMed

    Alexander, Pauline; Alkhawam, Lora; Curry, Jason; Levy, Phillip; Pang, Peter S; Storrow, Alan B; Collins, Sean P

    2015-02-01

    There are nearly 700,000 annual US emergency department (ED) visits for acute heart failure (AHF). Although blood pressure is elevated on most of these visits, acute therapy remains focused on preload and not afterload reduction. Data from recent prospective studies suggest that patients with AHF with concomitant acute hypertension benefit from intravenous (IV) vasodilators. To better understand the use of vasodilators for such patients, we conducted a systematic review of (1) currently available intravenous vasodilators for ED patients with AHF, or (2) intravenous vasodilators that are not yet available, but have completed phase III clinical trials in AHF, and may be available for ED use in the future. We used multiterm search queries to retrieve research involving nitroglycerin, nitroprusside, enalaprilat, hydralazine, relaxin, and nesiritide. A total of 2001 unique citations were identified from 3 databases: PubMed, EMBASE, and CINAHL. Of these, 1966 were excluded on the basis of established review criteria, leaving 35 published articles for inclusion. Our primary finding was that intravenous nitrovasodilators, when used in the treatment of AHF in ED and ED-like settings, do improve short-term symptoms and appear safe to administer. There are no data suggesting that they impact mortality. Other commonly used vasodilators such as hydralazine and enalaprilat have very little published data about their safety and efficacy. Of note, few studies enrolled patients early in their course of treatment. Thus, to assess the specific impact of vasodilator therapy on both short- and long-term outcomes, future research efforts should focus on patient recruitment in the ED setting. PMID:25530194

  7. Association between low-dose pulsed intravenous cyclophosphamide therapy and amenorrhea in patients with systemic lupus erythematosus: A case-control study

    PubMed Central

    2011-01-01

    Background The risk for amenorrhea following treatment of systemic lupus erythematosus (SLE) patients with low-dose intravenous cyclophosphamide (IVCY) has not been fully explored. Our objective was to ascertain the incidence of amenorrhea following treatment with low-dose IVCY and the association between amenorrhea and the clinical parameters of SLE. Methods A case-control retrospective study of premenopausal women ? 45 years old who had been treated for SLE with low-dose IVCY (500 mg/body/pulse) plus high-dose glucocorticoids (0.8-1.0 mg/kg/day of prednisolone; IVCY group) or glucocorticoids alone (0.8-1.0 mg/kg/day of prednisolone; steroid group) in our hospital from 2000 through 2009 was conducted using a questionnaire survey and medical record review. Results Twenty-nine subjects in the IVCY group and 33 subjects in the steroid group returned the questionnaire. A multivariate analysis revealed that age at initiation of treatment ? 40 years old was significantly associated with amenorrhea [p = 0.009; odds ratio (OR) 10.2; 95% confidence interval (CI) 1.8-58.7]. IVCY treatment may display a trend for association with amenorrhea (p = 0.07; OR 2.9; 95% CI 0.9-9.4). Sustained amenorrhea developed in 4 subjects in the IVCY group and 1 subject in the steroid group; all of these patients were ? 40 years old. Menses resumed in all subjects < 40 years old, irrespective of treatment. Conclusions Although low-dose IVCY may increase the risk for amenorrhea, our data suggest that patients < 40 years old have a minimum risk for sustained amenorrhea with low-dose IVCY treatment. A higher risk for sustained amenorrhea following treatment with IVCY is a consideration for patients ? 40 years old. PMID:21663683

  8. Clinical Efficacy of Intravenous followed by Oral Azithromycin Monotherapy in Hospitalized Patients with Community-Acquired Pneumonia

    PubMed Central

    Plouffe, Joseph; Schwartz, Douglas B.; Kolokathis, Antonia; Sherman, Bruce W.; Arnow, Paul M.; Gezon, John A.; Suh, Byungse; Anzuetto, Antonio; Greenberg, Richard N.; Niederman, Michael; Paladino, Joseph A.; Ramirez, Julio A.; Inverso, Jill; Knirsch, Charles A.

    2000-01-01

    The purpose of this study was to evaluate intravenous (i.v.) azithromycin followed by oral azithromycin as a monotherapeutic regimen for community-acquired pneumonia (CAP). Two trials of i.v. azithromycin used as initial monotherapy in hospitalized CAP patients are summarized. Clinical efficacy is reported from an open-label randomized trial of azithromycin compared to cefuroxime with or without erythromycin. Bacteriologic and clinical efficacy results are also presented from a noncomparative trial of i.v. azithromycin that was designed to give additional clinical experience with a larger number of pathogens. Azithromycin was administered to 414 patients: 202 and 212 in the comparative and noncomparative trials, respectively. The comparator regimen was used as treatment for 201 patients; 105 were treated with cefuroxime alone and 96 were given cefuroxime plus erythromycin. In the comparative trial, clinical outcome data were available for 268 evaluable patients with confirmed CAP at the 10- to 14-day visit, with 106 (77%) of the azithromycin patients cured or improved and 97 (74%) of the comparator patients cured or improved. Mean i.v. treatment duration and mean total treatment duration (i.v. and oral) for the clinically evaluable patients were significantly (P < 0.05) shorter for the azithromycin group (3.6 days for the i.v. group and 8.6 days for the i.v. and oral group) than for the evaluable patients given cefuroxime plus erythromycin (4.0 days for the i.v. group and 10.3 days for the i.v. and oral group). The present comparative study demonstrates that initial therapy with i.v. azithromycin for hospitalized patients with CAP is associated with fewer side effects and is equal in efficacy to a 1993 American Thoracic Society-suggested regimen of cefuroxime plus erythromycin when the erythromycin is deemed necessary by clinicians. PMID:10858333

  9. Conjugation of vitamin E analog ?-TOS to Pt(IV) complexes for dual-targeting anticancer therapy

    E-print Network

    Suntharalingam, Kogularamanan

    We report two platinum(IV) complexes conjugated with a vitamin E analog, ?-tocopherol succinate (?-TOS). One of the conjugates displays the activity of both cisplatin and ?-TOS in cancer cells, causing damage to DNA and ...

  10. Bilateral atypical insufficiency fractures of the proximal tibia and a unilateral distal femoral fracture associated with long-term intravenous bisphosphonate therapy: a case report

    PubMed Central

    2012-01-01

    Introduction Atypical insufficiency fractures of the femur in patients on long-term bisphosphonate therapy have been well described in recent literature. The majority of cases are associated with minimal or no trauma and occur in the subtrochanteric or diaphyseal region. Case presentation We describe the case of a 76-year-old British Caucasian woman who presented initially to an emergency department and then to her primary care physician with a long-standing history of bilateral knee pain after minor trauma. Plain radiographs showed subtle linear areas of sclerosis bilaterally in her proximal tibiae. Magnetic resonance imaging confirmed the presence of insufficiency fractures in these areas along with her left distal femur. There are very few reports of atypical insufficiency fractures involving the tibia in patients on long-term bisphosphonate therapy and this appears to be the only documented bilateral case involving the metaphyseal regions of the proximal tibia and distal femur. Conclusion In addition to existing literature describing atypical fractures in the proximal femur and femoral shaft, there is a need for increased awareness that these fractures can also occur in other weight-bearing areas of the skeleton. All clinicians involved in the care of patients taking long-term bisphosphonates need to be aware of the growing association between new onset lower limb pain and atypical insufficiency fractures. PMID:22309438

  11. Intravenous injections in neonatal mice.

    PubMed

    Gombash Lampe, Sara E; Kaspar, Brian K; Foust, Kevin D

    2014-01-01

    Intravenous injection is a clinically applicable manner to deliver therapeutics. For adult rodents and larger animals, intravenous injections are technically feasible and routine. However, some mouse models can have early onset of disease with a rapid progression that makes administration of potential therapies difficult. The temporal (or facial) vein is just anterior to the ear bud in mice and is clearly visible for the first two days after birth on either side of the head using a dissecting microscope. During this window, the temporal vein can be injected with volumes up to 50 ?l. The injection is safe and well tolerated by both the pups and the dams. A typical injection procedure is completed within 1-2 min, after which the pup is returned to the home cage. By the third postnatal day the vein is difficult to visualize and the injection procedure becomes technically unreliable. This technique has been used for delivery of adeno-associated virus (AAV) vectors, which in turn can provide almost body-wide, stable transgene expression for the life of the animal depending on the viral serotype chosen. PMID:25407048

  12. The use of intravenous palivizumab for treatment of persistent RSV infection in children with leukemia.

    PubMed

    Santos, Roberto P; Chao, Jeffery; Nepo, Anne G; Butt, Shafiq; Stellrecht, Kathleen A; Pearce, Jennifer M; Lepow, Martha L

    2012-12-01

    Palivizumab is a humanized monoclonal antibody used to decrease the threat of respiratory syncytial virus (RSV) infection among children at high risk. There are no standard guidelines due to conflicting data on palivizumab's use in the treatment of RSV lower respiratory tract infections. Intravenous (IV) palivizumab was shown to be well tolerated and associated with decreased mortality in high-risk children who have RSV disease. However, it did not prevent lower respiratory tract infections and did not affect the survival rate of allogeneic stem cell transplant recipients who had RSV infection. We present 2 children with acute lymphocytic leukemia (ALL) and persistent RSV infection while receiving chemotherapy. Patient A is a 4-year-old male with Down syndrome, ALL, and persistent RSV infection for at least 3 months. Patient B is a 3-year-old female with pre-B cell ALL whose chemotherapy intensification phase was delayed due to a month-long RSV infection. RSV infections were determined by using real-time polymerase chain reaction assays from nasopharyngeal swabs before IV palivizumab therapy; patient A was positive for RSV at 36 cycles and patient B was positive for RSV at 29 cycles. RSV infection was cleared in both patients within 72 hours after receiving IV palivizumab (patient A: 16 mg/kg; patient B: 15 mg/kg). IV palivizumab may be a treatment option for persistent RSV infection among immunocompromised patients. PMID:23147965

  13. Evaluation of Bleeding Rates in Renal Transplant Patients on Therapeutic Intravenous Heparin

    PubMed Central

    Ringenberg, Theresa; Desanto, Heather; Opsha, Yekaterina; Costello, Jennifer; Schiller, Daryl

    2013-01-01

    Background: It is unknown whether coagulation properties differ between renal transplant and nontransplant patients. Objective: To assess whether renal transplant patients on intravenous (IV) heparin, titrated to therapeutic activated partial thromboplastin times (aPPT; 56-93 seconds), experienced a higher rate of bleeding compared to nontransplant patients. Methods: Twenty-nine renal transplant and 29 nontransplant patients receiving IV heparin for a deep vein thrombosis, pulmonary embolism, atrial fibrillation, or acute coronary syndrome were randomly identified through a retrospective chart review. Results: Renal transplant patients had higher bleeding rates on IV heparin therapy compared to nontransplant patients (31% vs 6.9%, respectively; P = .041). Renal transplant patients experienced a drop in hemoglobin of at least 1 g/dL or the need for a transfusion more often then nontransplant patients (69% vs 45%, respectively; P = .111), although the difference was not statistically significant. Conclusions: Further research is necessary to identify the factors contributing to increased rates of bleeding in renal transplant patients on IV heparin and to determine the ideal aPTT to appropriately balance anticoagulation in renal transplant patients. PMID:24474835

  14. High dose intravenous iron, mineral homeostasis and intact FGF23 in normal and uremic rats

    PubMed Central

    2013-01-01

    Background High iron load might have a number of toxic effects in the organism. Recently intravenous (iv) iron has been proposed to induce elevation of fibroblast growth factor 23 (FGF23), hypophosphatemia and osteomalacia in iron deficient subjects. High levels of FGF23 are associated with increased mortality in the chronic kidney disease (CKD) population. CKD patients are often treated with iv iron therapy in order to maintain iron stores and erythropoietin responsiveness, also in the case of not being iron depleted. Therefore, the effect of a single high iv dose of two different iron preparations, iron isomaltoside 1000 (IIM) and ferric carboxymaltose (FCM), on plasma levels of FGF23 and phosphate was examined in normal and uremic iron repleted rats. Methods Iron was administered iv as a single high dose of 80 mg/kg bodyweight and the effects on plasma levels of iFGF23, phosphate, Ca2+, PTH, transferrin, ferritin and iron were examined in short and long term experiments (n?=?99). Blood samples were obtained at time 0, 30, 60, 180 minutes, 24 and 48 hours and in a separate study after 1 week. Uremia was induced by 5/6-nephrectomy. Results Nephrectomized rats had significant uremia, hyperparathyroidism and elevated FGF23. Iron administration resulted in significant increases in plasma ferritin levels. No significant differences were seen in plasma levels of iFGF23, phosphate and PTH between the experimental groups at any time point within 48 hours or at 1 week after infusion of the iron compounds compared to vehicle. Conclusions In non-iron depleted normal and uremic rats a single high dose of either of two intravenous iron preparations, iron isomaltoside 1000, and ferric carboxymaltose, had no effect on plasma levels of iFGF23 and phosphate for up to seven days. PMID:24373521

  15. Maternal Intravenous Treatment with either Azithromycin or Solithromycin Clears Ureaplasma parvum from the Amniotic Fluid in an Ovine Model of Intrauterine Infection

    PubMed Central

    Miura, Yuichiro; Payne, Matthew S.; Keelan, Jeffrey A.; Noe, Andres; Carter, Sean; Watts, Rory; Spiller, Owen B.; Jobe, Alan H.; Kallapur, Suhas G.; Saito, Masatoshi; Stock, Sarah J.; Newnham, John P.

    2014-01-01

    Intrauterine infection with Ureaplasma spp. is strongly associated with preterm birth and adverse neonatal outcomes. We assessed whether combined intraamniotic (IA) and maternal intravenous (IV) treatment with one of two candidate antibiotics, azithromycin (AZ) or solithromycin (SOLI), would eradicate intrauterine Ureaplasma parvum infection in a sheep model of pregnancy. Sheep with singleton pregnancies received an IA injection of U. parvum serovar 3 at 85 days of gestational age (GA). At 120 days of GA, animals (n = 5 to 8/group) received one of the following treatments: (i) maternal IV SOLI with a single IA injection of vehicle (IV SOLI only); (ii) maternal IV SOLI with a single IA injection of SOLI (IV+IA SOLI); (iii) maternal IV AZ and a single IA injection of vehicle (IV AZ only); (iv) maternal IV AZ and a single IA injection of AZ (IV+IA AZ); or (v) maternal IV and single IA injection of vehicle (control). Lambs were surgically delivered at 125 days of GA. Treatment efficacies were assessed by U. parvum culture, quantitative PCR, enzyme-linked immunosorbent assay, and histopathology. Amniotic fluid (AF) from all control animals contained culturable U. parvum. AF, lung, and chorioamnion from all AZ- or SOLI-treated animals (IV only or IV plus IA) were negative for culturable U. parvum. Relative to the results for the control, the levels of expression of interleukin 1? (IL-1?), IL-6, IL-8, and monocyte chemoattractant protein 2 (MCP-2) in fetal skin were significantly decreased in the IV SOLI-only group, the MCP-1 protein concentration in the amniotic fluid was significantly increased in the IV+IA SOLI group, and there was no significant difference in the histological inflammation scoring of lung or chorioamnion among the five groups. In the present study, treatment with either AZ or SOLI (IV only or IV+IA) effectively eradicated macrolide-sensitive U. parvum from the AF. There was no discernible difference in antibiotic therapy efficacy between IV-only and IV+IA treatment regimens relative to the results for the control. PMID:24982089

  16. The vascular response observation by the monitoring of the photosensitizer, oxygen, and blood flow during the high intensity pulsed excitation photodynamic therapy 1h after water-soluble photosensitizer intravenous injection

    NASA Astrophysics Data System (ADS)

    Hakomori, S.; Matsuo, H.; Arai, T.

    2008-02-01

    We investigated the correlation between the therapeutic effect by early irradiation Photodynamic Therapy (PDT) and vascular response. The early irradiation PDT has been proposed by our group. This PDT protocol is that pulse laser irradiates to tumors 1 h after intravenous injection of water-soluble photosensitizer. The intact layer appeared over the well treated layer, when the early irradiation PDT was performed at rat prostate subcutaneous tumors with high intensity pulse laser (over 1 MW/cm2 in peak intensity) and Talaporfin sodium. In order to clarify the phenomenon mechanism, we monitored blood volume, surface temperature, photosensitizer amount, and oxygen saturation during the PDT. The rat prostate subcutaneous tumor was irradiated with excimer dye laser light at 1 h after the intravenous injection. The photosensitizer dose wa 2.0 mg/kg, and the pulse energy density was 2.5 mJ/cm2 (low intensity) or 10 mJ/cm2 (high intensity). Under the low intensity pulsed PDT, the fluorescence amount was decreasing gently during the irradiation, and the blood volume and oxygen saturation started decreasing just after the irradiation. Under the hgh intensity pulsed PDT, the fluorescence amount was decreaased rapidly for 20 s after the irradiation started. The blood volume and oxygen saturation were temporally decreased during the irradiation, and recovered at 48 hrs after the irradiation. According to these results, under the low intensity pulsed PDT, the blood vessel located near the surface started closing just after the irradiation. On the other hand, under the high intensity pulsed PDT the blood vessel was closing for 20 s after the irradiation started, moreover, the blood flow recovered at 48 hrs after the irradiation. We concluded that the vascular response depended on the pulse energy density, and then the therapeutic effect was attributed to the difference of the vascular response. In other words, the surface intact layer could be considered to be induced the temporal drug and oxygen depletion effect associated with the temporal vascular shutdown.

  17. Physician-Delivered Injection Therapies for Mechanical Neck Disorders: A Systematic Review Update (Non-Oral, Non-Intravenous Pharmacological Interventions for Neck Pain)

    PubMed Central

    Gross, Anita R.; Peloso, Paul M.; Galway, Erin; Navasero, Neenah; Essen, Karis Van; Graham, Nadine; Goldsmith, Charlie H; Gzeer, Wisam; Shi, Qiyun; Haines, Ted and COG

    2013-01-01

    Background: Controversy persists regarding medicinal injections for mechanical neck disorders (MNDs). Objectives: To determine the effectiveness of physician-delivered injections on pain, function/disability, quality of life, global perceived effect and patient satisfaction for adults with MNDs. Search Methods: We updated our previous searches of CENTRAL, MEDLINE and EMBASE from December 2006 through to March 2012. Selection Criteria: We included randomized controlled trials of adults with neck disorders treated by physician-delivered injection therapies. Data Collection and Analysis: Two authors independently selected articles, abstracted data and assessed methodological quality. When clinical heterogeneity was absent, we combined studies using random-effects models. Results: We included 12 trials (667 participants). No high or moderate quality studies were found with evidence of benefit over control. Moderate quality evidence suggests little or no difference in pain or function/disability between nerve block injection of steroid and bupivacaine vs bupivacaine alone at short, intermediate and long-term for chronic neck pain. We found limited very low quality evidence of an effect on pain with intramuscular lidocaine vs control for chronic myofascial neck pain. Two low quality studies showed an effect on pain with anaesthetic nerve block vs saline immediately post treatment and in the short-term. All other studies were of low or very low quality with no evidence of benefit over controls. Authors' Conclusions: Current evidence does not confirm the effectiveness of IM-lidocaine injection for chronic mechanical neck pain nor anaesthetic nerve block for cervicogenic headache. There is moderate evidence of no benefit for steroid blocks vs controls for mechanical neck pain. PMID:24155806

  18. The Effect of Intravenous Vitamin C on Cancer- and Chemotherapy-Related Fatigue and Quality of Life

    PubMed Central

    Carr, Anitra C.; Vissers, Margreet C. M.; Cook, John S.

    2014-01-01

    Cancer patients commonly experience a number of symptoms of disease progression and the side-effects of radiation therapy and adjuvant chemotherapy, which adversely impact on their quality of life (QOL). Fatigue is one of the most common and debilitating symptom reported by cancer patients and can affect QOL more than pain. Several recent studies have indicated that intravenous (IV) vitamin C alleviates a number of cancer- and chemotherapy-related symptoms, such as fatigue, insomnia, loss of appetite, nausea, and pain. Improvements in physical, role, cognitive, emotional, and social functioning, as well as an improvement in overall health, were also observed. In this mini review, we briefly cover the methods commonly used to assess health-related QOL in cancer patients, and describe the few recent studies examining the effects of IV vitamin C on cancer- and chemotherapy-related QOL. We discuss potential mechanisms that might explain an improvement in QOL and also considerations for future studies. PMID:25360419

  19. Bloodstream Infections in Patients With Pulmonary Arterial Hypertension Treated With Intravenous Prostanoids: Insights From the REVEAL REGISTRY®

    PubMed Central

    Kitterman, Natalie; Poms, Abby; Miller, Dave P.; Lombardi, Sandra; Farber, Harrison W.; Barst, Robyn J.

    2012-01-01

    Objective To evaluate the rate of and potential risk factors for bloodstream infections (BSIs) using data from the REVEAL (Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension [PAH] Disease Management) REGISTRY®, which provides current information about patients with PAH. Patients and Methods Patients were enrolled from March 30, 2006, through December 8, 2009, and data on reported BSIs were collected through the third quarter of 2010. Bloodstream infection rates were calculated per 1000 patient-days of risk. Results Of 3518 patients enrolled, 1146 patients received intravenous (IV) prostanoid therapy for more than 1 day (no BSI, n=1023; ?1 BSI, n=123; total BSI episodes, n=166). Bloodstream infections rates were significantly increased in patients receiving IV treprostinil vs IV epoprostenol (0.36 vs 0.12 per 1000 treatment days; P<.001), primarily due to gram-negative organisms (0.20 vs 0.03 per 1000 treatment days; P<.001). Multivariate analysis adjusting for age, causes of PAH, and year of BSI found that treatment with IV treprostinil was associated with a 3.08-fold increase (95% confidence interval, 2.05-4.62; P<.001) in BSIs of any type and a 6.86-fold increase (95% confidence interval, 3.60-13.07; P<.001) in gram-negative BSIs compared with treatment with IV epoprostenol. Conclusion Compared with IV epoprostenol therapy, treatment with IV treprostinil is associated with a significantly higher rate of gram-negative BSIs; observed differences in BSI rate did not seem to be due to any other analyzed factors. Trial Registration clinicaltrials.gov Identifier: NCT00370214 PMID:22883740

  20. Intravenous regional anaesthesia

    Microsoft Academic Search

    Corinna M. Matt

    2007-01-01

    Intravenous regional anaesthesia (IVRA) was first described almost a century ago by August Bier and has been used for the past 50 years. It is a safe anaesthetic technique for upper or lower distal limb surgery. It utilizes a tourniquet, ideally a double tourniquet, followed by exsanguination of the appropriate limb after insertion of a cannula, through which local anaesthetic

  1. Intravenous regional anesthesia

    Microsoft Academic Search

    Narinder Rawal

    2000-01-01

    Intravenous regional anesthesia (IVRA) is one of the most common regional techniques worldwide. The mechanism of action is multifactorial but the main action of the local anesthetic seems to be on the larger nerves in the vicinity of the antecubital fossa. Prilocaine is considered the safest local anesthetic for IVRA. Lidocaine is most commonly used in the USA. Recently, ropivacaine

  2. Peripheral intravenous line - infants

    MedlinePLUS

    A peripheral intravenous line (PIV) is a small, short, plastic tube, called a catheter. A health care provider puts the PIV through the skin into a vein in the scalp, hand, arm, or foot. This article addresses PIVs in babies. Why is a PIV ...

  3. Intravenous regional anesthesia using lidocaine and ketorolac.

    PubMed

    Reuben, S S; Steinberg, R B; Kreitzer, J M; Duprat, K M

    1995-07-01

    Nonsteroidal antiinflammatory drugs (NSAIDs) interfere with the synthesis of inflammatory mediators and can supplement postoperative pain relief. We postulated that using the parenterally available NSAID ketorolac (K) as a component of intravenous regional anesthesia (IVRA) would suppress intraoperative tourniquet pain and enhance postoperative analgesia. Sixty patients were assigned randomly and blindly to receive either intravenous (i.v.) saline and IVRA with 0.5% lidocaine, IV K and IVRA 0.5% lidocaine, or i.v. saline and IVRA 0.5% lidocaine with K. The patients who received IVRA K reported significantly less intraoperative tourniquet pain, with lower verbal analog pain scores at 15 and 30 min after tourniquet inflation. Similarly, IVRA-K patients experienced less postoperative pain with lower visual analog scale (VAS) pain scores at 30 and 60 min, and required no fentanyl for control of early postoperative pain in the postanesthesia care unit (PACU). They also required fewer analgesic tablets in the first 24 h (1.9 +/- 1.4 Tylenol No. 3 tablets compared to the other two groups, 4.6 +/- 1.3 and 3.0 +/- 1.1; P < 0.05). We conclude that K improves IVRA with 0.5% lidocaine both in terms of controlling intraoperative tourniquet pain and by diminishing postoperative pain. PMID:7598236

  4. Gender differences in the intravenous self-administration of mu opiate agonists

    E-print Network

    Steinbach, Joe Henry

    Gender differences in the intravenous self-administration of mu opiate agonists Theodore J. Cicero Gender differences have been observed in a number of aspects of the pharmacology of opiates, including gender differences exist in the intravenous (IV) self-administration of opiates in an operant

  5. Hemodynamic effects of ambrisentan-tadalafil combination therapy on progressive portopulmonary hypertension

    PubMed Central

    Yamashita, Yu; Tsujino, Ichizo; Sato, Takahiro; Yamada, Asuka; Watanabe, Taku; Ohira, Hiroshi; Nishimura, Masaharu

    2014-01-01

    Intravenous epoprostenol is recommended for World Health Organization functional class (WHO-FC) IV patients with pulmonary arterial hypertension (PAH) in the latest guidelines. However, in portopulmonary hypertension (PoPH) patients, advanced liver dysfunction and/or thrombocytopenia often makes the use of intravenous epoprostenol challenging. Here we report the cases of two WHO-FC IV PoPH patients who were successfully treated with a combination of two oral vasodilators used to treat PAH: ambrisentan and tadalafil. Oral vasodilator therapy using a combination of ambrisentan and tadalafil may be a safe and effective therapeutic option for WHO-FC IV PoPH patients and should be considered for selected patients with severe and rapidly progressing PoPH. PMID:25429321

  6. Hemodynamic effects of ambrisentan-tadalafil combination therapy on progressive portopulmonary hypertension.

    PubMed

    Yamashita, Yu; Tsujino, Ichizo; Sato, Takahiro; Yamada, Asuka; Watanabe, Taku; Ohira, Hiroshi; Nishimura, Masaharu

    2014-11-27

    Intravenous epoprostenol is recommended for World Health Organization functional class (WHO-FC) IV patients with pulmonary arterial hypertension (PAH) in the latest guidelines. However, in portopulmonary hypertension (PoPH) patients, advanced liver dysfunction and/or thrombocytopenia often makes the use of intravenous epoprostenol challenging. Here we report the cases of two WHO-FC IV PoPH patients who were successfully treated with a combination of two oral vasodilators used to treat PAH: ambrisentan and tadalafil. Oral vasodilator therapy using a combination of ambrisentan and tadalafil may be a safe and effective therapeutic option for WHO-FC IV PoPH patients and should be considered for selected patients with severe and rapidly progressing PoPH. PMID:25429321

  7. Intravenous Cocaine Priming Reinstates Cocaine-Induced Conditioned Place Preference

    ERIC Educational Resources Information Center

    Lombas, Andres S.; Freeman, Kevin B.; Roma, Peter G.; Riley, Anthony L.

    2007-01-01

    Separate groups of rats underwent an unbiased conditioned place preference (CPP) procedure involving alternate pairings of distinct environments with intravenous (IV) injections of cocaine (0.75 mg/kg) or saline immediately or 15 min after injection. A subsequent extinction phase consisted of exposure to both conditioning environments preceded by…

  8. Hypotensive effects of intravenously administered uridine and cytidine in conscious rats: Involvement of adenosine receptors

    Microsoft Academic Search

    M. Sertac Yilmaz; Cenk Coskun; Oner Suzer; Murat Yalcin; Duygu Mutlu; Vahide Savci

    2008-01-01

    In the present study, we investigated the cardiovascular effects of intravenously injected uridine or cytidine, and the role of adenosine receptors in mediating these effects, in conscious normotensive rats. Intravenous (i.v.) administration of uridine (124, 250, 500 mg\\/kg) dose-dependently decreased arterial pressure and heart rate. Cytidine (124, 250, 500 mg\\/kg; i.v.) produced slight dose-related hypotension without changing heart rate. Plasma uridine and

  9. Intravenous fentanyl kinetics

    Microsoft Academic Search

    Deborah A McClain; Carl C Hug

    1980-01-01

    Fentanyl is considered to be a short-acting narcotic analgesic but prolonged and recurrent ventilatory depression has been reported. We examined fentanyl kinetics and excretion in 7 healthy male subjects who were given a 3.2- or 6.4-?g\\/kg dose of 3H-fentanyi intravenously. Arterial blood and urine samples were analyzed for unchanged fentanyl and total radioactivity. Fentanyl concentrations fell rapidly and 98.6% of

  10. Early intravenous beta-blockers in patients with acute coronary syndrome–A meta-analysis of randomized trials

    PubMed Central

    Chatterjee, Saurav; Chaudhuri, Debanik; Vedanthan, Rajesh; Fuster, Valentin; Ibanez, Borja; Bangalore, Sripal; Mukherjee, Debabrata

    2014-01-01

    Background Intravenous (IV) beta-blockade is currently a Class IIa recommendation in early management of patients with acute coronary syndromes (ACS) without obvious contraindications. Methods We searched the PubMed, EMBASE and the Cochrane Register for Controlled Clinical Trials for randomized clinical trials from 1965 through December, 2011, comparing intravenous beta-blockers administered within 12 hours of presentation of ACS with standard medical therapy and/or placebo. The primary outcome assessed was the risk of short-term (in-hospital mortality-with maximum follow up duration of 90 days) all-cause mortality in the intervention group versus the comparator group. The secondary outcomes assessed were ventricular tachyarrhythmias, myocardial reinfarction, cardiogenic shock, and stroke. Pooled treatment effects were estimated using relative risk with Mantel–Haenszel risk ratio, using a random-effects model. Results Sixteen studies enrolling 73,396 participants met the inclusion / exclusion criteria. In- hospital mortality was reduced 8% with intravenous beta-blockers, RR=0.92 (95% CI, 0.86–1.00; p=0.04) when compared with controls. Moreover, intravenous beta-blockade reduced the risk of ventricular tachyarrhythmias (RR=0.61; 95 % CI 0.47–0.79; p=0.0003) and myocardial reinfarction (RR=0.73, 95 % CI 0.59–0.91; p=0.004) without increase in the risk of cardiogenic shock, (RR=1.02; 95% CI 0.77–1.35; p=0.91) or stroke (RR=0.58; 95 % CI 0.17–1.98; p=0.38). Conclusions Intravenous beta-blockers early in the course of appropriate patients with ACS appears to be associated with significant reduction in the risk of short-term cardiovascular outcomes, including a reduction in the risk of all-cause mortality. PMID:23168009

  11. Peripheral intravenous cannulation: managing distress and anxiety.

    PubMed

    McGowan, Donna

    2014-10-22

    It is recognised that peripheral intravenous (IV) cannulation is an increasingly performed procedure within the hospital setting. This invasive, yet necessary, procedure often causes patients considerable anxiety and distress, especially those patients who have to endure multiple and possibly painful and difficult cannulations. Nurses can play a valuable role in minimising the associated physical discomfort and complications that patients may experience as a result of having a peripheral cannula inserted through maintaining their knowledge and skills in relation to patient preparation, assessment and the care and management of the cannula. However, nurses also play an equally valuable role in recognising the potential psychological complications that are associated with peripheral IV cannulation. Demonstrating a knowledge and understanding of the effective methods that are used to manage and minimise these complications can ensure patients' confidence is maintained and their experience of cannulation is positive. PMID:25345479

  12. VAC Therapy in Large Infected Sacral Pressure Ulcer Grade IV-Can Be an Alternative to Flap Reconstruction?

    PubMed

    Batra, R K; Aseeja, Veena

    2014-04-01

    Vacuum-assisted closure (VAC) therapy is a new entrant in wound care after growth factors and alginate or hydrocolloid dressing, in the treatment of pressure ulcers. We have been using this technique for diabetic foot ulcers. A young nondiabetic man presented with a large sacral bed sore after high doses of ionotropes in an intensive care unit for treating severe hypotension. His wound was debrided, and instead of flap surgery in such infected wound, he was treated with VAC therapy. The complete wound healing was achieved in 6 weeks and at half the cost of flap surgery. Moreover, the chances of flap failure and its related complications were eliminated. PMID:24891788

  13. Impact of Consolidation Radiation Therapy in Stage III-IV Diffuse Large B-cell Lymphoma With Negative Post-Chemotherapy Radiologic Imaging

    SciTech Connect

    Dorth, Jennifer A., E-mail: jennifer.dorth@duke.edu [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Prosnitz, Leonard R. [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States)] [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Broadwater, Gloria [Cancer Statistical Center, Duke University Medical Center, Durham, North Carolina (United States)] [Cancer Statistical Center, Duke University Medical Center, Durham, North Carolina (United States); Diehl, Louis F.; Beaven, Anne W. [Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, North Carolina (United States)] [Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, North Carolina (United States); Coleman, R. Edward [Department of Radiology, Division of Nuclear Medicine, Duke University Medical Center, Durham, North Carolina (United States)] [Department of Radiology, Division of Nuclear Medicine, Duke University Medical Center, Durham, North Carolina (United States); Kelsey, Chris R. [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States)] [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States)

    2012-11-01

    Purpose: While consolidation radiation therapy (i.e., RT administered after chemotherapy) is routine treatment for patients with early-stage diffuse large B-cell lymphoma (DLBCL), the role of consolidation RT in stage III-IV DLBCL is controversial. Methods and Materials: Cases of patients with stage III-IV DLBCL treated from 1991 to 2009 at Duke University, who achieved a complete response to chemotherapy were reviewed. Clinical outcomes were calculated using the Kaplan-Meier method and were compared between patients who did and did not receive RT, using the log-rank test. A multivariate analysis was performed using Cox proportional hazards model. Results: Seventy-nine patients were identified. Chemotherapy (median, 6 cycles) consisted of anti-CD20 antibody rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP; 65%); cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP; 22%); or other (13%). Post-chemotherapy imaging consisted of positron emission tomography (PET)/computed tomography (CT) (73%); gallium with CT (14%); or CT only (13%). Consolidation RT (median, 25 Gy) was given to involved sites of disease in 38 (48%) patients. Receipt of consolidation RT was associated with improved in-field control (92% vs. 69%, respectively, p = 0.028) and event-free survival (85% vs. 65%, respectively, p = 0.014) but no difference in overall survival (85% vs. 78%, respectively, p = 0.15) when compared to patients who did not receive consolidation RT. On multivariate analysis, no RT was predictive of increased risk of in-field failure (hazard ratio [HR], 8.01, p = 0.014) and worse event-free survival (HR, 4.3, p = 0.014). Conclusions: Patients with stage III-IV DLBCL who achieve negative post-chemotherapy imaging have improved in-field control and event-free survival with low-dose consolidation RT.

  14. The Effects of Wilderness Therapy on the Clinical Concerns (on Axes I, II, and IV) of Troubled Adolescents

    ERIC Educational Resources Information Center

    Clark, Jeffrey R; Marmol, Leonardo M.; Cooley, Robert; Gathercoal, Kathleen

    2004-01-01

    The purpose of this study was twofold: (a) to empirically evaluate the effects of a 21-day wilderness therapy program (WT) on the defense styles, perceived psychosocial stressors (expressed concerns), dysfunctional personality patterns, clinical syndromes, and maladaptive behaviors of 109 troubled adolescents, as measured by the Defense Style…

  15. Oral/intravenous maintenance dosing of valproate following intravenous loading: a simulation.

    PubMed

    Dutta, Sandeep; Cloyd, James C; Granneman, G Richard; Collins, Stephen D

    2003-02-01

    Valproic acid (VPA) has a narrow therapeutic range (50-100mg/l) and exhibits nonlinear protein binding. Additionally, VPA pharmacokinetics are dependent on age, induction status, and formulation; so titration and dosing vary between individuals. The aim of these simulations was to determine optimal intravenous (i.v.) loading dose, and i.v. and oral VPA maintenance regimens. A 5-min 15mg/kg loading dose resulted in total and free plasma VPA concentrations of approximately 65 and 7.5mg/l in children, and approximately 80 and 11mg/l in adults, 1h after the infusion; induction status had little effect. For uninduced children and adults, 7.5 and 3.5mg/kg q6h i.v. valproate sodium, initiated 6h after loading dose maintains therapeutic plasma VPA concentrations. The rapid decline of plasma VPA concentrations following an i.v. loading dose in combination with the delayed initial absorption of drug from delayed-release divalproex sodium tablets warrant beginning q12h oral maintenance regimens of delayed-release divalproex sodium within 2h of a loading dose in the uninduced population. Plasma VPA concentrations can be sustained in the therapeutic range using once-daily maintenance regimens of extended-release divalproex sodium tablets if initiated concurrently with i.v. loading dose in the uninduced population. A two-fold higher i.v. and oral maintenance regimen dose may be required in induced patients. PMID:12576165

  16. Multiple Intravenous Infusions Phase 1b

    PubMed Central

    Cassano-Piché, A; Fan, M; Sabovitch, S; Masino, C; Easty, AC

    2012-01-01

    Background Minimal research has been conducted into the potential patient safety issues related to administering multiple intravenous (IV) infusions to a single patient. Previous research has highlighted that there are a number of related safety risks. In Phase 1a of this study, an analysis of 2 national incident-reporting databases (Institute for Safe Medical Practices Canada and United States Food and Drug Administration MAUDE) found that a high percentage of incidents associated with the administration of multiple IV infusions resulted in patient harm. Objectives The primary objectives of Phase 1b of this study were to identify safety issues with the potential to cause patient harm stemming from the administration of multiple IV infusions; and to identify how nurses are being educated on key principles required to safely administer multiple IV infusions. Data Sources and Review Methods A field study was conducted at 12 hospital clinical units (sites) across Ontario, and telephone interviews were conducted with program coordinators or instructors from both the Ontario baccalaureate nursing degree programs and the Ontario postgraduate Critical Care Nursing Certificate programs. Data were analyzed using Rasmussen’s 1997 Risk Management Framework and a Health Care Failure Modes and Effects Analysis. Results Twenty-two primary patient safety issues were identified with the potential to directly cause patient harm. Seventeen of these (critical issues) were categorized into 6 themes. A cause-consequence tree was established to outline all possible contributing factors for each critical issue. Clinical recommendations were identified for immediate distribution to, and implementation by, Ontario hospitals. Future investigation efforts were planned for Phase 2 of the study. Limitations This exploratory field study identifies the potential for errors, but does not describe the direct observation of such errors, except in a few cases where errors were observed. Not all issues are known in advance, and the frequency of errors is too low to be observed in the time allotted and with the limited sample of observations. Conclusions The administration of multiple IV infusions to a single patient is a complex task with many potential associated patient safety risks. Improvements to infusion and infusion-related technology, education standards, clinical best practice guidelines, hospital policies, and unit work practices are required to reduce the risk potential. This report makes several recommendations to Ontario hospitals so that they can develop an awareness of the issues highlighted in this report and minimize some of the risks. Further investigation of mitigating strategies is required and will be undertaken in Phase 2 of this research. Plain Language Summary Patients, particularly in critical care environments, often require multiple intravenous (IV) medications via large volumetric or syringe infusion pumps. The infusion of multiple IV medications is not without risk; unintended errors during these complex procedures have resulted in patient harm. However, the range of associated risks and the factors contributing to these risks are not well understood. Health Quality Ontario’s Ontario Health Technology Advisory Committee commissioned the Health Technology Safety Research Team at the University Health Network to conduct a multi-phase study to identify and mitigate the risks associated with multiple IV infusions. Some of the questions addressed by the team were as follows: What is needed to reduce the risk of errors for individuals who are receiving a lot of medications? What strategies work best? The initial report, Multiple Intravenous Infusions Phase 1a: Situation Scan Summary Report, summarizes the interim findings based on a literature review, an incident database review, and a technology scan. The Health Technology Safety Research Team worked in close collaboration with the Institute for Safe Medication Practices Canada on an exploratory study to understand the risks associated with multiple IV infusions and th

  17. Therapeutic Targets and Drugs IV: Telomerase-Specific Gene and Vector-Based Therapies for Human Cancer

    Microsoft Academic Search

    Toshiyoshi Fujiwara; Yasuo Urata; Noriaki Tanaka

    \\u000a Recent advances in genetic engineering technology have opened a new avenue of gene-and vector-based therapies for human cancer.\\u000a For targeting cancer cells, there is a need for tissue- or cell-specific promoters that can express in diverse tumor types\\u000a but are silent in normal cells. Genetic approaches fostered remarkable insights into the molecular basis of neoplasm, and\\u000a a number of oncotropic

  18. Intravenous cannulation of adolescents does not affect the modulation of autonomic tone assessed by heart rate and blood pressure variability

    Microsoft Academic Search

    Julian M. Stewart

    2000-01-01

    Invasive arterial monitoring alters autonomic tone. The effects of intravenous (IV) insertion are less clear. The author assessed the effects of IV insertion on autonomic activity in patients aged 11 to 19 years prior to head-up tilt by measuring heart rate, blood pressure, heart rate variability, blood pressure variability, and baroreceptor gain before and after IV insertion with continuous electrocardiography

  19. Entolimod in Treating Patients With Stage III-IV Squamous Cell Head and Neck Cancer Receiving Cisplatin and Radiation Therapy

    ClinicalTrials.gov

    2013-12-10

    Mucositis; Recurrent Squamous Cell Carcinoma of the Hypopharynx; Recurrent Squamous Cell Carcinoma of the Larynx; Recurrent Squamous Cell Carcinoma of the Lip and Oral Cavity; Recurrent Squamous Cell Carcinoma of the Nasopharynx; Recurrent Squamous Cell Carcinoma of the Oropharynx; Recurrent Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Recurrent Verrucous Carcinoma of the Larynx; Recurrent Verrucous Carcinoma of the Oral Cavity; Stage III Squamous Cell Carcinoma of the Hypopharynx; Stage III Squamous Cell Carcinoma of the Larynx; Stage III Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage III Squamous Cell Carcinoma of the Nasopharynx; Stage III Squamous Cell Carcinoma of the Oropharynx; Stage III Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Stage III Verrucous Carcinoma of the Larynx; Stage III Verrucous Carcinoma of the Oral Cavity; Stage IV Squamous Cell Carcinoma of the Hypopharynx; Stage IV Squamous Cell Carcinoma of the Nasopharynx; Stage IVA Squamous Cell Carcinoma of the Larynx; Stage IVA Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage IVA Squamous Cell Carcinoma of the Oropharynx; Stage IVA Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Stage IVA Verrucous Carcinoma of the Larynx; Stage IVA Verrucous Carcinoma of the Oral Cavity; Stage IVB Squamous Cell Carcinoma of the Larynx; Stage IVB Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage IVB Squamous Cell Carcinoma of the Oropharynx; Stage IVB Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Stage IVB Verrucous Carcinoma of the Larynx; Stage IVB Verrucous Carcinoma of the Oral Cavity; Stage IVC Squamous Cell Carcinoma of the Larynx; Stage IVC Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage IVC Squamous Cell Carcinoma of the Oropharynx; Stage IVC Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Stage IVC Verrucous Carcinoma of the Larynx; Stage IVC Verrucous Carcinoma of the Oral Cavity; Tongue Cancer

  20. Combination Chemotherapy With or Without Monoclonal Antibody Therapy in Treating Patients With Stage III or Stage IV Low-Grade Non-Hodgkin's Lymphoma

    ClinicalTrials.gov

    2013-02-26

    Stage III Grade 1 Follicular Lymphoma; Stage III Grade 2 Follicular Lymphoma; Stage III Grade 3 Follicular Lymphoma; Stage III Small Lymphocytic Lymphoma; Stage IV Grade 1 Follicular Lymphoma; Stage IV Grade 2 Follicular Lymphoma; Stage IV Grade 3 Follicular Lymphoma; Stage IV Small Lymphocytic Lymphoma

  1. The FIND-CKD study—a randomized controlled trial of intravenous iron versus oral iron in non-dialysis chronic kidney disease patients: background and rationale

    PubMed Central

    Macdougall, Iain C.; Bock, Andreas; Carrera, Fernando; Eckardt, Kai-Uwe; Gaillard, Carlo; Van Wyck, David; Roubert, Bernard; Cushway, Timothy; Roger, Simon D.

    2014-01-01

    Background Rigorous data are sparse concerning the optimal route of administration and dosing strategy for iron therapy with or without concomitant erythropoiesis-stimulating agent (ESA) therapy for the management of iron deficiency anaemia in patients with non-dialysis dependent chronic kidney disease (ND-CKD). Methods FIND-CKD was a 56-week, open-label, multicentre, prospective, randomized three-arm study (NCT00994318) of 626 patients with ND-CKD and iron deficiency anaemia randomized to (i) intravenous (IV) ferric carboxymaltose (FCM) at an initial dose of 1000 mg iron with subsequent dosing as necessary to target a serum ferritin level of 400–600 µg/L (ii) IV FCM at an initial dose of 200 mg with subsequent dosing as necessary to target serum ferritin 100–200 µg/L or (iii) oral ferrous sulphate 200 mg iron/day. The primary end point was time to initiation of other anaemia management (ESA therapy, iron therapy other than study drug or blood transfusion) or a haemoglobin (Hb) trigger (two consecutive Hb values <10 g/dL without an increase of ?0.5 g/dL). Results The background, rationale and study design of the trial are presented here. The study has been completed and results are expected in late 2013. Discussion FIND-CKD was the longest randomized trial of IV iron therapy to date. Its findings will address several unanswered questions regarding iron therapy to treat iron deficiency anaemia in patients with ND-CKD. It was also the first randomized trial to utilize both a high and low serum ferritin target range to adjust IV iron dosing, and the first not to employ Hb response as its primary end point. PMID:24170814

  2. Risk perception, risk taking and risk management among intravenous drug users: Implications for AIDS prevention

    Microsoft Academic Search

    Margaret M. Connors

    1992-01-01

    The risks associated with AIDS transmission among intravenous drug users overlap with a constellation of other risk events common in the use of IV drugs. This paper explores the subcultural definition, meaning and use of risk from the experience of the active user. In assessing the extent and nature of risk among IV drug users, street-based ethnographic research was conducted

  3. Three Monthly Intravenous Injections of Ibandronate in the Treatment of Postmenopausal Osteoporosis

    Microsoft Academic Search

    D Thiébaud; P Burckhardt; H Kriegbaum; H Huss; H Mulder; J. R Juttmann; K. H Schöter

    1997-01-01

    PURPOSE: Oral treatment of osteoporosis with bisphosphonates relies on compliance, the absorption being low and suppressed by simultaneous food intake. Intravenous (IV) treatment with an aminobisphosphonate, pamidronate (once every 3 months) was effective, but required infusions. Ibandronate, a new very potent aminobisphosphonate, can be administered safely as an IV bolus injection, and therefore offers an interesting alternative suitable for outpatient

  4. An observational study of intravenous medication errors in the United Kingdom and in Germany

    Microsoft Academic Search

    V. Wirtz; Nick D. Barber; K. taxis

    2003-01-01

    Objectives: To investigate the incidence and the severity of intravenous (i.v.) drug preparation and administration errors in two countries and three pharmacy services. Method: A disguised observational method was used to record details of the preparation and administration of prescribed i.v. drugs on two wards in each of three teaching hospitals: one with a traditional British ward pharmacy service (TBP)

  5. Cisplatin, gemcitabine, and treosulfan in relapsed stage IV cutaneous malignant melanoma patients.

    PubMed

    Atzpodien, J; Terfloth, K; Fluck, M; Reitz, M

    2007-11-19

    To evaluate the efficacy of cisplatin, gemcitabine, and treosulfan (CGT) in 91 patients with pretreated relapsed AJCC stage IV cutaneous malignant melanoma. Patients in relapse after first-, second-, or third-line therapy received 40 mg m(-2) intravenous (i.v.) cisplatin, 1000 mg m(-2) i.v. gemcitabine, and 2500 mg m(-2) i.v. treosulfan on days 1 and 8. Cisplatin, gemcitabine, and treosulfan therapy was repeated every 5 weeks until progression of disease occurred. A maximum of 11 CGT cycles (mean, two cycles) was administered per patient. Four patients (4%) showed a partial response; 15 (17%) patients had stable disease; and 72 (79%) patients progressed upon first re-evaluation. Overall survival of all 91 patients was 6 months (2-year survival rate, 7%). Patients with partial remission or stable disease exhibited a median overall survival of 11 months (2-year survival rate, 36%), while patients with disease progression upon first re-evaluation had a median overall survival of 5 months (2-year survival rate, 0%). Treatment with CGT was efficient in one-fifth of the pretreated relapsed stage IV melanoma patients achieving disease stabilisation or partial remission with prolonged but limited survival. PMID:17971774

  6. Wireless Application in Intravenous Infiltration Detection System

    PubMed Central

    Alley, Matthew S.; Naramore, William J.; Chou, Nee-Yin; Winchester, Leonard W.

    2008-01-01

    The IrDA wireless protocol has been applied to a fiber optics based point-of-care system for the detection of intravenous infiltration. The system is used for monitoring patients under infusion therapy. It is optimized for portability by incorporating a battery source and wireless communication. The IrDA protocol provides secure data communication between the electronic module of the system and the PDAs carried by the nurses. The PDA is used for initiating the actions of the electronic module and for data transfer. Security is provided by specially designed software and hardware. PMID:19162821

  7. Darbepoetin alfa 300 or 500 ?g once every 3 weeks with or without intravenous iron in patients with chemotherapy-induced anemia.

    PubMed

    Auerbach, Michael; Silberstein, Peter T; Webb, R Timothy; Averyanova, Svetlana; Ciuleanu, Tudor-Eliade; Shao, James; Bridges, Kenneth

    2010-09-01

    This study evaluated efficacy and safety of darbepoetin alfa administered every 3 weeks (Q3W) at fixed doses of 300 or 500 ?g with or without intravenous (IV) iron in treating anemia in patients receiving multicycle chemotherapy. This Phase 2, double-blind, 2 × 2 factorial study randomized patients to one of four treatment arms; darbepoetin alfa 300 ?g (n = 62), darbepoetin alfa 300 ?g plus IV iron (n = 60), darbepoetin alfa 500 ?g (n = 60), or darbepoetin alfa 500 ?g plus IV iron (n = 60). Patients had nonmyeloid malignancies, hemoglobin levels ?10 g dL(-1), and no iron deficiency. Primary endpoint was achievement of target hemoglobin (?11 g dL(-1)). Secondary endpoints included incidence of transfusions and change in Functional Assessment of Cancer Therapy Fatigue (FACT-F) score from baseline to end of study. Safety was evaluated by incidence of adverse events. No evidence of a statistically significant interaction between darbepoetin alfa dose received and IV iron usage was observed, therefore, results are provided separately comparing darbepoetin alfa doses and comparing IV iron usage groups. Similar proportions of patients receiving darbepoetin alfa 300 or 500 ?g achieved target hemoglobin (75 and 78%, respectively); Kaplan-Meier median time to target hemoglobin was 10 and 8 weeks, respectively. More patients receiving IV iron (82%) than not receiving IV iron (72%) achieved hemoglobin target. Adverse events profiles were similar for darbepoetin alfa treatment groups. Transient anaphylactoid reactions were reported in two patients receiving IV iron. Darbepoetin alfa at 300 ?g Q3W and 500 ?g Q3W showed similar benefit, while added IV iron improved treatment response in these patients. PMID:20661916

  8. Intravenous leiomyomatosis with intracardiac involvement.

    PubMed

    Xia, Meng; Liu, Junxiu; Xiang, Xianhong; Xu, Ming; He, Mian

    2014-09-01

    Intravenous leiomyomatosis with intracardiac involvement is rare. This is a case report of a 52-year-old female with intravenous leiomyomatosis with intracardiac involvement. She was successfully treated with myomatectomy (left renal vein and inferior vena cava), hysterectomy, and bilateral salpingo-oophorectomy under the cardiopulmonary bypass. PMID:24838291

  9. Empiric Oral versus Intravenous Antibiotics for Low-Risk Febrile Neutropenia: a Meta-analysis

    Microsoft Academic Search

    Marissa M. Alejandria; Mario M. Panaligan; Felice G. Molina; Maria Fe; P. Raymundo

    Empiric intravenous antimicrobial therapy is the current standard of management for patients with febrile neutropenia. The use of oral antibiotic regimens for low-risk febrile neutropenia is a potentially cost-effective alternative if proven to be equally effective as the standard intravenous regimens. It is the objective of the study to determine if oral antibiotic regimens are equally effective as the standard

  10. Intravenous gamma-globulin treatment in a patient with subacute sclerosing panencephalitis.

    PubMed

    Gürer, Y K; Kükner, S; Sarica, B

    1996-01-01

    A 10-year-old boy with subacute sclerosing panencephalitis was treated with intravenous gamma-globulin and inosiplex and followed for 18 months. Clinical improvement, demonstrated by decreasing scores on the Neurologic Disability Index, was observed. There were no side effects. We recommend intravenous immune globulin as an alternative therapy in the treatment of subacute sclerosing panencephalitis. PMID:8652024

  11. Intravascular bubbles associated with intravenous injections and altitude

    NASA Technical Reports Server (NTRS)

    Cooke, J. P.; Olson, R. M.; Holden, R. D.

    1976-01-01

    Ultrasonically detected microbubbles were more abundant in the pulmonary artery of dogs intravenously injected with 10 ml of saline than in the same noninjected control during 10,000 ft (3,048 m), 20,000 ft (6,096 m), and 40,000 ft (12,121 m) exposures. Continuous intravenous (i.v.) drip infusions also introduced many small bubbles. Since they may serve as 'nuclei' for visible intravascular bubble formation, are sometimes associated with decompression sickness, and are additionally considered undesirable, it would appear prudent to minimize i.v. injections immediately before flights. However, a 10-min delay before ascent wil reduce their number and a 60-min delay will insure their almost complete absence. Also, slow ascent, a 1-h denitrogenation time, or use of a degassed solution will help reduce their total number.

  12. Intravenous Artesunate for Severe Malaria in Travelers, Europe

    PubMed Central

    Junghanss, Thomas; Kapaun, Annette; Gjørup, Ida; Richter, Joachim; Hugo-Persson, Mats; Mørch, Kristine; Foroutan, Behruz; Suttorp, Norbert; Yürek, Salih; Flick, Holger

    2011-01-01

    Multicenter trials in Southeast Asia have shown better survival rates among patients with severe malaria, particularly those with high parasitemia levels, treated with intravenous (IV) artesunate than among those treated with quinine. In Europe, quinine is still the primary treatment for severe malaria. We conducted a retrospective analysis for 25 travelers with severe malaria who returned from malaria-endemic regions and were treated at 7 centers in Europe. All patients survived. Treatment with IV artesunate rapidly reduced parasitemia levels. In 6 patients at 5 treatment centers, a self-limiting episode of unexplained hemolysis occurred after reduction of parasitemia levels. Five patients required a blood transfusion. Patients with posttreatment hemolysis had received higher doses of IV artesunate than patients without hemolysis. IV artesunate was an effective alternative to quinine for treatment of malaria patients in Europe. Patients should be monitored for signs of hemolysis, especially after parasitologic cure. PMID:21529383

  13. Gefitinib and Radiation Therapy With or Without Cisplatin in Treating Patients With Stage III or Stage IV Head and Neck Cancer

    ClinicalTrials.gov

    2013-01-24

    Stage III Squamous Cell Carcinoma of the Hypopharynx; Stage III Squamous Cell Carcinoma of the Larynx; Stage III Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage III Squamous Cell Carcinoma of the Oropharynx; Stage IV Squamous Cell Carcinoma of the Hypopharynx; Stage IV Squamous Cell Carcinoma of the Larynx; Stage IV Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage IV Squamous Cell Carcinoma of the Oropharynx

  14. Intravenous iron administration in a short-stay hospital setting.

    PubMed

    Peebles, George; Fenwick, Sean

    Anaemia and iron deficiency are prevalent in the Western and developing world. They have implications for quality of life, prognosis and survival in a number of clinical settings. These range from the implications of anaemic status and associated outcomes in pregnancy, reduced blood transfusion requirements following surgery to lethargy and tiredness in older people if left unrecognised and untreated. Renal medicine is at the forefront of diagnosing and treating anaemia associated with chronic renal disease. In this arena the role of intravenous (IV) iron is well established. This article describes how IV iron may be given in total doses in a short-stay hospital setting. PMID:18727354

  15. Vaccine Therapy With Sargramostim (GM-CSF) in Treating Patients With Her-2 Positive Stage III-IV Breast Cancer or Ovarian Cancer

    ClinicalTrials.gov

    2014-05-05

    HER2-positive Breast Cancer; Stage III Ovarian Epithelial Cancer; Stage III Ovarian Germ Cell Tumor; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer; Stage IV Breast Cancer; Stage IV Ovarian Epithelial Cancer; Stage IV Ovarian Germ Cell Tumor

  16. Haemodynamic response to intravenous vasopressin and nitroglycerin in portal hypertension

    Microsoft Academic Search

    D Westaby; A Gimson; P C Hayes; R Williams

    1988-01-01

    We have evaluated the haemodynamic effects of intravenous (iv) nitroglycerin (NG) and vasopressin (VP) alone and in combination, in 12 patients with cirrhosis and recent variceal haemorrhage (two to seven days). Nitroglycerin infusion alone (200 micrograms\\/min) produced a significant fall in portal pressure (WHVP-FHVP) (from 16.4 (0.6) to 13.3 (1.2) mmHg; p less than .001) associated with hypotension (mean arterial

  17. Utilization Patterns of IV Iron and Erythropoiesis Stimulating Agents in Anemic Chronic Kidney Disease Patients: A Multihospital Study

    PubMed Central

    Joshi, Avani D.; Holdford, David A.; Brophy, Donald F.; Harpe, Spencer E.; Mays, Darcy; Gehr, Todd W. B.

    2012-01-01

    Intravenous (IV) iron and Erythropoiesis Stimulating Agents (ESAs) are recommended for anemia management in chronic kidney disease (CKD). This retrospective cohort study analyzed utilization patterns of IV iron and ESA in patients over 18 years of age admitted to University Health System Hospitals with a primary or secondary diagnosis of CKD between January 1, 2006 to December 31, 2008. A clustered binomial logistic regression using the GEE methodology was used to identify predictors of IV iron utilization. Only 8% (n = 6678) of CKD patients on ESA therapy received IV iron supplementation in university hospitals. Those receiving iron used significantly less amounts of ESAs. Patient demographics (age, race, primary payer), patient clinical conditions (admission status, severity of illness, dialysis status), and physician specialty were identified as predictors of IV iron use in CKD patients. Use of IV iron with ESAs was low despite recommendations from consensus guidelines. The low treatment rate of IV iron represents a gap in treatment practices and signals an opportunity for healthcare improvement in CKD anemic patients. PMID:22577528

  18. Intravenous naphazoline intoxication.

    PubMed

    van Montfrans, G A; van Steenwijk, R P; Vyth, A; Borst, C

    1981-01-01

    Nine pale perspiring drug addicts with drowsiness, nausea, headache, normal blood pressure and marked sinus bradycardia with premature ventricular beats were seen at the Casualty Department soon after alleged i.v. cocaine administration. Eight were treated with atropine, as the bradycardia suggested intoxication with a parasympathomimetic compound. Seven were discharged in good condition after a few hours' observation. One patient developed a blood pressure of 150/120 mmHg after atropine. Subsequently, a hemiparesis was found and an intracerebral haematoma was evaluated at surgery. Another patient was admitted forthwith to the CCU. He did not receive any medication and recovered within two days. Urinalysis of these two patients disclosed contents of naphazoline, a powerful alpha-adrenergic agent. Samples of the alleged cocaine contained 97% naphazoline HCl. A conscious rabbit was injected with naphazoline and thereafter with atropine. I.v. naphazoline doubled mean arterial pressure (MAP) and reduced heart rate (HR) from 167 to 30 beats/min. Atropine doubled HR, but caused a marked rise in MAP, too, stressing the adverse effects of atropine in these cases. When confronted with patients after alleged cocaine abuse, the role of substitute drugs, especially alpha-adrenergic compounds, should be considered as this should influence the therapeutic approach. PMID:7246278

  19. Subcutaneous Bortezomib in Multiple Myeloma Patients Induces Similar Therapeutic Response Rates as Intravenous Application But It Does Not Reduce the Incidence of Peripheral Neuropathy

    PubMed Central

    Minarik, Jiri; Pavlicek, Petr; Pour, Ludek; Pika, Tomas; Maisnar, Vladimir; Spicka, Ivan; Jarkovsky, Jiri; Krejci, Marta; Bacovsky, Jaroslav; Radocha, Jakub; Straub, Jan; Kessler, Petr; Wrobel, Marek; Walterova, Lenka; Sykora, Michal; Obernauerova, Jarmila; Brozova, Lucie; Gregora, Evzen; Adamova, Dagmar; Gumulec, Jaromir; Adam, Zdenek; Scudla, Vlastimil; Hajek, Roman

    2015-01-01

    Objective Subcutaneous (SC) application of bortezomib has been recently introduced as a new application route in multiple myeloma (MM) patients. We performed an analysis to compare the outcomes of bortezomib-based therapy in multiple myeloma (MM) patients treated using either intravenous (IV) or subcutaneous (SC) route of administration. Patients and methods During January 2012 through December 2013, we performed a retrospective analysis of 446 patients with MM treated with bortezomib-based regimens (either once weekly – 63% or twice weekly – 27%) in both, the first line setting, and in relapse, with separate analysis of patients undergoing autologous stem cell transplantation. We assessed the response rates and toxicity profiles in both, IV and SC route of bortezomib administration. Results The response rates in both IV and SC arm were similar with overall response rate 71.7% vs 70.7%, complete remissions in 13.9% vs 8.6%, very good partial remissions in 30.8% vs 34.5% and partial remissions in 27% vs 27.6%. The most frequent grade ?3 toxicities were anemia, thrombocytopenia and neutropenia, with no significant differences between IV and SC group. There were no significant differences in the rate of peripheral neuropathy (PN). PN of any grade was present in 48% in the IV arm and in 41% in the SC arm. PN grade ?2 was present in 20% vs 18% and PN grade ?3 was present in 6% vs 4%. Conclusions We conclude that subcutaneous application of bortezomib has similar therapeutic outcomes and toxicity profile as intravenous route of application. In our cohort there was no difference in the incidence of PN, suggesting that PN is dose dependent and might be reduced by lower intensity schemes rather than by the route of administration. PMID:25875484

  20. Transitioning safely from intravenous to subcutaneous insulin.

    PubMed

    Kreider, Kathryn Evans; Lien, Lillian F

    2015-05-01

    The transition from intravenous (IV) to subcutaneous (SQ) insulin in the hospitalized patient with diabetes or hyperglycemia is a key step in patient care. This review article suggests a stepwise approach to the transition in order to promote safety and euglycemia. Important components of the transition include evaluating the patient and clinical situation for appropriateness, recognizing factors that influence a safe transition, calculation of proper SQ insulin doses, and deciding the appropriate type of SQ insulin. This article addresses other clinical situations including the management of patients previously on insulin pumps and recommendations for patients requiring glucocorticoids and enteral tube feedings. The use of institutional and computerized protocols is discussed. Further research is needed regarding the transition management of subgroups of patients such as those with type 1 diabetes and end-stage renal disease. PMID:25772640

  1. Cisplatin and Radiation Therapy With or Without Erlotinib Hydrochloride in Treating Patients With Stage III or Stage IV Head and Neck Cancer

    ClinicalTrials.gov

    2013-05-08

    Stage III Squamous Cell Carcinoma of the Hypopharynx; Stage III Squamous Cell Carcinoma of the Larynx; Stage III Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage III Squamous Cell Carcinoma of the Nasopharynx; Stage III Squamous Cell Carcinoma of the Oropharynx; Stage IV Squamous Cell Carcinoma of the Hypopharynx; Stage IV Squamous Cell Carcinoma of the Larynx; Stage IV Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage IV Squamous Cell Carcinoma of the Nasopharynx; Stage IV Squamous Cell Carcinoma of the Oropharynx

  2. Plasma and dermal pharmacokinetics of terpinen-4-ol in rats following intravenous administration.

    PubMed

    Chooluck, K; Singh, R P; Sathirakul, K; Derendorf, H

    2013-02-01

    Terpinen-4-ol, a naturally occurring monoterpene, has been shown to possess antibacterial, antioxidant and anti-inflammatory activities. Furthermore, recent reports have demonstrated that terpinen-4-ol could be developed as new therapies against melanoma either in systemic administration or targeted drug delivery. The purpose of this study was to investigate the pharmacokinetics of terpinen-4-ol in rat plasma and dermal tissue following intravenous (i.v.) bolus injection of terpinen-4-ol at a dose of 2 mg/kg. Unbound concentrations of terpinen-4-ol in dermis were continuously determined by dermal microdialysis. Simultaneously, a conventional blood sampling was performed. The concentrations of terpinen-4-ol in plasma and microdialysates were determined by validated gas chromatography-mass spectrometry. Following i.v. bolus administration, terpinen-4-ol rapidly distributed into the dermis and reached relatively low levels with an average maximum concentration (Cmax) of 0.10 +/- 0.06 microg/ml in comparison with a plasma Cmax of 6.30 +/- 1.90 microg/ml. The free terpinen-4-ol concentrations in dermal tissue were lower than the corresponding total and free plasma concentrations for the entire length of study, indicating that plasma levels do not provide information of actual terpinen-4-ol concentrations in the skin. This study demonstrates that dermal microdialysis is an effective and minimally invasive tool to evaluate the dermal pharmacokinetics of terpinen-4-ol following systemic administration. PMID:23469686

  3. A new approach to intravenous regional anesthesia.

    PubMed

    Abdulla, W Y; Fadhil, N M

    1992-10-01

    In an attempt to reduce the dose of local anesthetic during intravenous (IV) regional anesthesia of the upper limb, we combined 100 mg of lidocaine with 0.05 mg of fentanyl and 0.5 mg of pancuronium. The study was designed in a randomized, double-blind fashion to determine the efficacy of this approach in providing analgesia and relaxation during surgery and to evaluate its safety after immediate deflation of the tourniquet following IV drug injection. Eighty unpremedicated patients, ASA physical status I or II, were assigned to the following groups: group A (n = 15) received 100 mg of lidocaine diluted in 40 mL of NaCl IV; groups B-D (n = 15 in each group) received 100 mg of lidocaine diluted in NaCl, with the addition of 0.05 mg of fentanyl (group B) or 0.5 mg of pancuronium (group C), or both (group D) to a total volume in all groups of 40 mL. Patients in groups A-D underwent elective operations on the forearm, wrist, and hand; for evaluation of safety, in 20 volunteers (group E) the tourniquet was immediately released after IV injection of the three drugs at the previously described doses. The analgesic effect was more profound in group D compared with groups A-C. In group D, 9 of 15 patients had excellent analgesia. In six patients, pain was experienced at the beginning of surgery, but 5 min thereafter patients remained pain free.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1530172

  4. Stroke Therapy Academic Industry Roundtable (STAIR) Recommendations For Extended Window Acute Stroke Therapy Trials

    PubMed Central

    Saver, Jeffrey L.; Albers, Gregory W.; Dunn, Billy; Johnston, Karen C.; Fisher, Marc

    2009-01-01

    The Stroke Therapy Academic Industry Roundtable (STAIR) meetings focus on helping to advance the development of acute stroke therapies. Further extending the time window for acute stroke therapies is an important endeavor for increasing the number of stroke patients who might benefit from treatment. The STAIR group recommends that future extended time window trials initially should focus on selected patient groups most likely to respond to investigational therapies and that penumbral imaging is one tool that may identify such patients. The control group in these trials should receive best locally available medical care; if regulatory approval for intravenous (i.v.) tPA is extended to 4.5 hours, then tPA will become the most appropriate comparator in trials conducted within this time window. In future well-designed extended window clinical trials randomization is appropriate and should not be precluded by using unproven treatment with intra-arterial (i.a.) thrombolysis or mechanical devices. For proof of concept, extended time window, phase II trials of i.v. thrombolysis or mechanical devices in which early recanalization/reperfusion is the primary endpoint, rescue therapy/bailout treatment with i.a. thrombolysis or devices may be acceptable. Statistical considerations and definitions of successful recanalization/reperfusion are suggested for these trials. PMID:19478212

  5. Efficacy and safety of erythropoietin and intravenous iron in perioperative blood management: a systematic review.

    PubMed

    Lin, David M; Lin, Estelle S; Tran, Minh-Ha

    2013-10-01

    The use of erythropoietin (EPO) and intravenous (IV) iron as bloodless therapeutic modalities is being explored in the current era of restrictive transfusion strategies and perioperative blood management. It is unclear, however, whether the evidence in the literature supports their safety and efficacy in reducing perioperative red cell transfusions. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we conducted a systematic review to evaluate their use in a variety of perioperative settings. We performed a literature search of English articles published between July 1997 and July 2012 in MEDLINE via PubMed, The Cochrane Library, and CINAHL. Only studies with a comparator group were eligible for inclusion. Twenty-four randomized controlled trials (RCTs) and 15 nonrandomized studies were included in the final review. Using the Cochrane risk of bias tool, 8 RCTs were assessed to be at low risk for methodological bias. Of these, however, only 4 RCTs were adequately powered to detect a reduction in transfusion rates. Patients with preoperative iron deficiency anemia may have an earlier and more robust hemoglobin recovery with preoperative IV iron therapy than with oral iron supplementation. A short preoperative regimen of EPO, or a single dose of EPO plus IV iron in the preoperative or intraoperative period, may significantly reduce transfusion rates (number needed to treat to avoid any transfusion ranged from 3 to 6). With regard to the safety of erythropoietin-stimulating agent therapy, IV iron appears to be as well tolerated as oral iron; however, the incidence of severe anaphylactic-type reactions attributable to IV iron is difficult to estimate in prospective trials because of its relatively infrequent occurrence. Furthermore, EPO may increase the risk of thromboembolism in spinal surgery patients who receive mechanical antithrombotic prophylaxis in the perioperative period so pharmacological thromboprophylaxis is advised. Future low risk of bias, adequately powered prospective efficacy, and safety trials in various surgical settings that traditionally require red cell transfusions would be required to make evidenced-based conclusions about the clinical significance of erythropoietin-stimulating agent as a transfusion avoidance strategy in perioperative blood management. PMID:24135037

  6. Intra-arterial versus intra-venous thrombolysis within and after the first 3 hours of stroke onset

    PubMed Central

    Majaz, Moonis

    2010-01-01

    The NINDS trial demonstrated for the first time the effectiveness of intravenous thrombolysis in improving outcome after acute ischemic stroke. The absolute benefit of this intervention was 11–13% greater chance of being normal or near normal (MRS ? 1) at 3 months. However, if patients with severe stroke were considered (NIHSS ? 20), the absolute benefit dropped to 5–6%, indicating that IV thrombolysis may not be as effective for large vessel occlusion. This observation was further supported by TCD studies that clearly demonstrated that large artery occlusions had a recanalization rate of 13–18% with IV rt-PA. Intra-arterial thrombolysis achieves recanalization rates of 60–70%. Since tissue viability is clearly important, it is time to stop defining rigid time windows and if there is a large penumbra (20–50%) and the occlusion is in a large artery, there exists a logic and a growing evidence to consider either bridge therapy or direct intra-arterial therapy. PMID:22371764

  7. Economic Model for Emergency Use Authorization of Intravenous Peramivir

    PubMed Central

    Lee, Bruce Y.; Tai, Julie H. Y.; Bailey, Rachel R.; McGlone, Sarah M.; Wiringa, Ann E.; Zimmer, Shanta M.; Smith, Kenneth J.; Zimmerman, Richard K.

    2013-01-01

    Objectives To develop 3 computer simulation models to determine the potential economic effect of using intravenous (IV) antiviral agents to treat hospitalized patients with influenza-like illness, as well as different testing and treatment strategies. Study Design Stochastic decision analytic computer simulation model. Methods During the 2009 influenza A(H1N1) pandemic, the Food and Drug Administration granted emergency use authorization of IV neuraminidase inhibitors for hospitalized patients with influenza, creating a need for rapid decision analyses to help guide use. We compared the economic value from the societal and third-party payer perspectives of the following 4 strategies for a patient hospitalized with influenza-like illness and unable to take oral antiviral agents: Strategy 1: Administration of IV antiviral agents without polymerase chain reaction influenza testing. Strategy 2: Initiation of IV antiviral treatment, followed by polymerase chain reaction testing to determine whether the treatment should be continued. Strategy 3: Performance of polymerase chain reaction testing, followed by initiation of IV antiviral treatment if the test results are positive. Strategy 4: Administration of no IV antiviral agents. Sensitivity analyses varied the probability of having influenza (baseline, 10%; range, 10%–30%), IV antiviral efficacy (baseline, oral oseltamivir phosphate; range, 25%–75%), IV antiviral daily cost (range, $20–$1000), IV antiviral reduction of illness duration (baseline, 1 day; range, 1–2 days), and ventilated vs nonventilated status of the patient. Results When the cost of IV antiviral agents was no more than $500 per day, the incremental cost-effectiveness ratio for most of the IV antiviral treatment strategies was less than $10,000 per quality-adjusted life-year compared with no treatment. When the cost was no more than $100 per day, all 3 IV antiviral strategies were even more cost-effective. The order of cost-effectiveness from most to least was strategies 3, 1, and 2. The findings were robust to changing risk of influenza, influenza mortality, IV antiviral efficacy, IV antiviral daily cost, IV antiviral reduction of illness duration, and ventilated vs nonventilated status of the patient for both societal and third-party payer perspectives. Conclusion Our study supports the use of IV antiviral treatment for hospitalized patients with influenza-like illness. PMID:21485418

  8. Detailed clinicopathological characterization of progressive alopecia areata patients treated with i.v. corticosteroid pulse therapy toward optimization of inclusion criteria.

    PubMed

    Sato, Misato; Amagai, Masayuki; Ohyama, Manabu

    2014-11-01

    The management of progressive alopecia areata (AA) is often challenging. Recently, i.v. corticosteroid pulse therapy has been reported to be effective for acute and severe AA, however, inclusion criteria have not been sufficiently precise, leaving a chance that its efficacy could be further improved by optimizing therapeutic indications. In our attempts to delineate the factors that correlate with favorable outcomes, we minutely evaluated the clinicopathological findings and the prognoses of single-round steroid pulse-treated progressive AA cases with full sets of image and pathology records during the course. Almost complete hair regrowth has been achieved and maintained up to 2 years in five out of seven AA patients with varying degrees of clinical severity. Interestingly, the worst clinical presentation observed during the course correlated with the size of the area where hairs with dystrophic roots were pulled rather than the extent of visible hair loss on the first visit. Dermoscopy detected disease spread but contributed little in assessing prognoses. Dense perifollicular cell infiltration was detected in all cases treated within 4 weeks of onset and those treated later but with excellent response. Importantly, the cases with poor or incomplete hair regrowth were treated 6-8 weeks of onset and showed moderate inflammatory change with high telogen conversion rate. These findings mandate global dermoscopy and hair pull test for judging the treatment indication and suggest that early administration of high-dose corticosteroid, ideally within 4 weeks of onset, enable efficient suppression of active inflammation and maximize the effectiveness of the remedy. PMID:25292350

  9. Vaccine Therapy in Treating Patients With Stage IIIC-IV Ovarian Epithelial, Fallopian Tube, or Primary Peritoneal Cavity Cancer Following Surgery and Chemotherapy

    ClinicalTrials.gov

    2014-12-15

    Ovarian Clear Cell Cystadenocarcinoma; Ovarian Endometrioid Adenocarcinoma; Ovarian Mixed Epithelial Carcinoma; Ovarian Mucinous Cystadenocarcinoma; Ovarian Serous Cystadenocarcinoma; Ovarian Undifferentiated Adenocarcinoma; Recurrent Fallopian Tube Cancer; Recurrent Ovarian Epithelial Cancer; Recurrent Primary Peritoneal Cavity Cancer; Stage IIIC Fallopian Tube Cancer; Stage IIIC Ovarian Epithelial Cancer; Stage IIIC Primary Peritoneal Cavity Cancer; Stage IV Fallopian Tube Cancer; Stage IV Ovarian Epithelial Cancer; Stage IV Primary Peritoneal Cavity Cancer

  10. In-flight demonstration of the Space Station Freedom Health Maintenance Facility fluid therapy system (E300/E05)

    NASA Technical Reports Server (NTRS)

    Lloyd, Charles W.

    1993-01-01

    The Space Station Freedom (SSF) Health Maintenance Facility (HMF) will provide medical care for crew members for up to 10 days. An integral part of the required medical care consists of providing intravenous infusion of fluids, electrolyte solutions, and nutrients to sustain an ill or injured crew member. In terrestrial health care facilities, intravenous solutions are normally stored in large quantities. However, due to the station's weight and volume constraints, an adequate supply of the required solutions cannot be carried onboard SSF. By formulating medical fluids onboard from concentrates and station water as needed, the Fluid Therapy System (FTS) eliminates weight and volume concerns regarding intravenous fluids. The first full-system demonstration of FTS is continuous microgravity will be conducted in Spacelab-Japan (SL-J). The FTS evaluation consists of two functional objectives and an in-flight demonstration of intravenous administration of fluids. The first is to make and store sterile water and IV solutions onboard the spacecraft. If intravenous fluids are to be produced in SSF, successful sterilization of water and reconstituting of IV solutions must be achieved. The second objective is to repeat the verification of the FTS infusion pump, which had been performed in Spacelab Life Sciences - 1 (SLS-1). during SLS-1, the FTS IV pump was operated in continuous microgravity for the first time. The pump functioned successfully, and valuable knowledge on its performance in continuous microgravity was obtained. Finally, the technique of starting an IF in microgravity will be demonstrated. The IV technique requires modifications in microgravity, such as use of restraints for equipment and crew members involved.

  11. Effect of intravenous or oral sodium chlorate administration on the fecal shedding of Escherichia coli in sheep

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The effect of gavage or intravenous (i.v.) administration of sodium chlorate salts on the fecal shedding of generic Escherichia coli in wether lambs was studied. To this end, 9 lambs (27 +/- 2.5 kg) were administered 150 mg NaClO3 per kg BW by gavage or i.v. infusion in a cross-over design with sal...

  12. EFFECTS OF CHLORDIMEFORM ON CARDIOVASCULAR FUNCTIONAL PARAMETERS. PART 2. ACUTE AND DELAYED EFFECTS FOLLOWING INTRAVENOUS ADMINISTRATION IN THE POSTWEANLING RAT

    EPA Science Inventory

    The differential effects of intravenous (IV) intraperitoneal (IP) administration of chlordimeform (CDM) were investigated in 22-30 day old pentobarbital-anesthetized Sprague-Dawley rats. The first group of animals (N=25) were given sequential IV injections of 5, 10, 30, 60, and 1...

  13. Early versus late treatment of spinal cord compression with long-term intrathecal enzyme replacement therapy in canine mucopolysaccharidosis type I

    PubMed Central

    Dickson, Patricia I.; Hanson, Stephen; McEntee, Michael F.; Vite, Charles H.; Vogler, Carole A.; Mlikotic, Anton; Chen, Agnes H.; Ponder, Katherine P.; Haskins, Mark E.; Tippin, Brigette L.; Le, Steven Q.; Passage, Merry B.; Guerra, Catalina; Dierenfeld, Ashley; Jens, Jackie; Snella, Elizabeth; Kan, Shih-hsin; Ellinwood, N. Matthew

    2010-01-01

    Enzyme replacement therapy (ERT) with intravenous recombinant human alpha-l-iduronidase (IV rhIDU) is a treatment for patients with mucopolysaccharidosis I (MPS I). Spinal cord compression develops in MPS I patients due in part to dural and leptomeningeal thickening from accumulated glycosaminoglycans (GAG). We tested long-term and every three month intrathecal (IT) and weekly IV rhIDU in MPS I dogs age 12-15 months (Adult) and MPS I pups age 2-23 days (Early) to determine whether spinal cord compression could be reversed, stabilized, or prevented. Five treatment groups of MPS I dogs were evaluated (n=4 per group): IT+IV Adult, IV Adult, IT+IV Early, 0.58 mg/kg IV Early and 1.57 mg/kg IV Early. IT+IV rhIDU (Adult and Early) led to very high iduronidase levels in cervical, thoracic, and lumber spinal meninges (3,600-29,000% of normal), while IV rhIDU alone (Adult and Early) led to levels that were 8.2-176% of normal. GAG storage was significantly reduced from untreated levels in spinal meninges of IT+IV Early (p<0.001), IT+IV Adult (p=0.001), 0.58 mg/kg IV Early (p=0.002) and 1.57 mg/kg IV Early (p<0.001) treatment groups. Treatment of dogs shortly after birth with IT+IV rhIDU (IT+IV Early) led to normal to near-normal GAG levels in the meninges and histologic absence of storage vacuoles. Lysosomal storage was reduced in spinal anterior horn cells in 1.57 mg/kg IV Early and IT+IV Early animals. All dogs in IT+IV Adult and IV Adult groups had compression of their spinal cord at 12-15 months of age determined by magnetic resonance imaging and was due to protrusion of spinal disks into the canal. Cord compression developed in 3 of 4 dogs in the 0.58 mg/kg IV Early group; 2 of 3 dogs in the IT+IV Early group; and 0 of 4 dogs in the 1.57 mg/kg IV Early group by 12-18 months of age. IT+IV rhIDU was more effective than IV rhIDU alone for treatment of meningeal storage, and it prevented meningeal GAG accumulation when begun early. High-dose IV rhIDU from birth (1.57 mg/kg weekly) appeared to prevent cord compression due to protrusion of spinal disks. PMID:20655780

  14. Onset and Duration of Intravenous and Intraosseous Rocuronium in Swine

    PubMed Central

    Loughren, Michael; Banks, Sarah; Naluan, Carleo; Portenlanger, Paul; Wendorf, Arthur; Johnson, Don

    2014-01-01

    Introduction The intraosseous (IO) route has become a popular method to gain access to the peripheral circulation in emergency situations. Despite little supporting data, it is generally believed that IO absorption is immediate and equivalent to the intravenous (IV) route. It is important to determine if rocuronium can effectively be administered by the IO route. The aim of the study was to determine and compare the onset and duration of rocuronium when administered via the IO and IV routes in a normovolemic pig model. Methods We recorded electromyographic (EMG) data following tibial IO and peripheral IV administration of rocuronium (1.2 mg/kg) in 10 swine weighing between 56 and 71 Kg. We transformed data were transformed to percent of baseline, determined onset and recovery characteristics. Results The onset EMG-time profiles for IO and IV administration were very similar: tibial IO compared to IV administration did not statistically alter the onset of paralysis. The IO group took statistically longer than the IV group to return to 50 (p=0.042), 75 (p=0.034) and 95 (p=0.036) percent of baseline activity. Conclusion The duration of effect is statistically longer after IO administration but is more of an academic interest than a clinical concern. The results of this study suggest that rocuronium can effectively be administered via the IO route without the need for dose adjustments. PMID:24672619

  15. Esophagoscopy in Evaluating Treatment in Patients With Stage I-IV Head and Neck Cancer Who Are Undergoing Radiation Therapy and/or Chemotherapy

    ClinicalTrials.gov

    2012-04-09

    Stage I Adenoid Cystic Carcinoma of the Oral Cavity; Stage I Mucoepidermoid Carcinoma of the Oral Cavity; Stage I Squamous Cell Carcinoma of the Hypopharynx; Stage I Squamous Cell Carcinoma of the Larynx; Stage I Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage I Verrucous Carcinoma of the Larynx; Stage I Verrucous Carcinoma of the Oral Cavity; Stage II Adenoid Cystic Carcinoma of the Oral Cavity; Stage II Mucoepidermoid Carcinoma of the Oral Cavity; Stage II Squamous Cell Carcinoma of the Hypopharynx; Stage II Squamous Cell Carcinoma of the Larynx; Stage II Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage II Verrucous Carcinoma of the Larynx; Stage II Verrucous Carcinoma of the Oral Cavity; Stage III Adenoid Cystic Carcinoma of the Oral Cavity; Stage III Mucoepidermoid Carcinoma of the Oral Cavity; Stage III Squamous Cell Carcinoma of the Hypopharynx; Stage III Squamous Cell Carcinoma of the Larynx; Stage III Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage III Verrucous Carcinoma of the Larynx; Stage III Verrucous Carcinoma of the Oral Cavity; Stage IV Adenoid Cystic Carcinoma of the Oral Cavity; Stage IV Mucoepidermoid Carcinoma of the Oral Cavity; Stage IV Squamous Cell Carcinoma of the Hypopharynx; Stage IV Squamous Cell Carcinoma of the Larynx; Stage IV Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage IV Verrucous Carcinoma of the Larynx; Stage IV Verrucous Carcinoma of the Oral Cavity

  16. Upfront triple combination therapy in pulmonary arterial hypertension: a pilot study.

    PubMed

    Sitbon, Olivier; Jaïs, Xavier; Savale, Laurent; Cottin, Vincent; Bergot, Emmanuel; Macari, Elise Artaud; Bouvaist, Hélène; Dauphin, Claire; Picard, François; Bulifon, Sophie; Montani, David; Humbert, Marc; Simonneau, Gérald

    2014-06-01

    Patients with severe pulmonary arterial hypertension (PAH) in New York Heart Association (NYHA) functional class (FC) III/IV have a poor prognosis, despite survival benefits being demonstrated with intravenous epoprostenol. In this pilot study, the efficacy and safety of a triple combination therapy regimen in patients with severe PAH was investigated. Data from newly diagnosed NYHA FC III/IV PAH patients (n=19) initiated on upfront triple combination therapy (intravenous epoprostenol, bosentan and sildenafil) were collected retrospectively from a prospective registry. Significant improvements in 6-min walk distance and haemodynamics were observed after 4 months' triple combination therapy in 18 patients (p<0.01); 17 patients had improved to NYHA FC I or II. One patient was not included in the month 4 assessment (due to an emergency lung transplant in month 3). At the final evaluation (mean ± sd 32 ± 19 months), all 18 patients had sustained clinical and haemodynamic improvement. Overall survival estimates for the triple combination cohort were 100% at 1, 2 and 3 years. Expected survival calculated from the French equation was 75% (95% CI 68-82%), 60% (95% CI 50-70%) and 49% (95% CI 38-60%) at 1, 2 and 3 years, respectively. This pilot study provides preliminary evidence of the long-term benefits of upfront triple combination therapy in patients with severe PAH. PMID:24627535

  17. Allogeneic hematopoietic cell transplantation for myelofibrosis using fludarabine-, intravenous busulfan- and low-dose TBI-based conditioning.

    PubMed

    Shanavas, M; Messner, H A; Atenafu, E G; Kim, D H; Kuruvilla, J; Lipton, J H; Uhm, J; Seftel, M; Alam, N; Gupta, V

    2014-09-01

    Graft failure is one of the major barriers to the success of allogeneic hematopoietic cell transplantation (HCT) in myelofibrosis (MF). We report our institutional experience with 27 MF patients who underwent HCT using fludarabine-, intravenous BU- and low-dose total body irradiation (FBT)-based reduced-intensity (n=20) or full-intensity (n=7) conditioning regimens. Eight patients had prior exposure to JAK1/2 inhibitor therapy; six patients received JAK1/2 inhibitors leading on to HCT and two patients received transplant at the failure of JAK1/2 inhibitor therapy. No adverse impact of JAK1/2 inhibitor therapy was observed on early post-transplant outcomes. All evaluable patients had neutrophil recovery, and no primary graft failure was observed. Cumulative incidence of grades II-IV acute GVHD at day 100 was 48% (95% confidence interval (CI), 29-67%) and chronic GVHD at 2 years was 66% (95% CI, 49-84%). Cumulative incidences of nonrelapse mortality (NRM), relapse and probability of OS at 2 years were: 43% (95% CI, 12-74%), 10% (95% CI, 0-39%) and 56% (95% CI, 28-77%), respectively. FBT-based conditioning regimen has a favorable impact on engraftment; however, further efforts are required to reduce NRM. PMID:24978138

  18. The comparative effects of single intravenous doses of cimetidine, ranitidine, famotidine, and omeprazole on intragastric PH

    Microsoft Academic Search

    Olivier Chassany; Jean Francois Bergmann; Guy Simoneau; Lisa Elouaer-Blanc; Jean Marc Segrestaa; Charles Caulin

    1996-01-01

    Twelve healthy subject participated in this randomized, double-masked, four-way crossover study to determine treatment schedules for intravenous (IV) administration of various gastric antisecretory drugs. Intragastric pH was monitored continuously for 14 hours after a single IV injection of cimetidine 300 mg, ranitidine 50 mg, famotidine 20 mg, or omeprazole 40 mg, each administered during one of four succcessive treatment periods

  19. The reinforcing and subjective effects of intravenous and intranasal buprenorphine in heroin users.

    PubMed

    Jones, Jermaine D; Madera, Gabriela; Comer, Sandra D

    2014-07-01

    Abuse of buprenorphine (BUP) by the intravenous (IV) route has been documented in several studies, and reports of intranasal (IN) abuse are increasing. However, no studies have directly compared the effects of BUP when it is administered intranasally and intravenously. The present secondary analysis used data from two separate studies to compare the reinforcing and subjective effects of IV and IN buprenorphine. One study evaluated IV buprenorphine (N=13) and the other evaluated IN buprenorphine (N=12). Participants were maintained on 2 mg sublingual (SL) BUP and tested with each intranasal or intravenous buprenorphine test dose (0 mg, 2 mg, 4 mg, 8 mg, and 16 mg). During morning laboratory sessions, participants received money (US $20) and sample doses of IN or IV BUP, and then completed subjective effects questionnaires. Later that day, they completed a self-administration task to receive 10% portions of the drug and/or money they previously sampled. In general, positive subjective ratings for both IV and IN BUP were significantly greater than placebo, with IV BUP having a greater effect than IN BUP. All active BUP doses (IV and IN) maintained significantly higher progressive ratio breakpoint values than placebo, but breakpoint values for IV BUP were greater than for IN BUP. Buprenorphine is an effective maintenance treatment for opioid dependence, valued for its ability to reduce the positive subjective effects of other opioids. Nevertheless, the present data demonstrate that in participants maintained on a low dose of SL BUP, the medication itself has abuse liability when used intravenously or intranasally. PMID:24793093

  20. Pharmacokinetics of chlorpheniramine after intravenous and oral administration in normal adults

    Microsoft Academic Search

    S. M. Huang; N. K. Athanikar; K. Sridhar; Y. C. Huang; W. L. Chiou

    1982-01-01

    Plasma and urinary levels of chlorpheniramine (CPM) and its 2 demethylated metabolites were measured by HPLC after i.v. and oral dosing. In 5 mg (maleate) i.v. bolus studies in 2 subjects, plasma CPM levels were fitted to triexponential equations with terminal half-lives (t1\\/2) of 23 and 22 h and area of 3.6 and 3.21\\/kg, respectively. Intravenous data predicted hepatic blood

  1. Paediatric acute basilar thrombosis successfully treated with intravenous alteplase

    PubMed Central

    Rego Sousa, Paulo; Vasconcellos, Rui

    2012-01-01

    Acute ischaemic stroke has significant attendant morbidity and is one of the top ten causes of childhood death. It requires prompt investigation and management, however little is known about the safety and efficacy of acute thrombolytic therapies in childhood arterial ischaemic stroke. The authors report a case of a 13-year-old girl with an acute basilar thrombosis, successfully treated with intravenous recombinant tissue plasminogen activator and discuss the management of paediatric arterial ischaemic stroke. PMID:22605850

  2. Intravenous urography and childhood trauma

    Microsoft Academic Search

    N. M. Okorie; A. E. MacKinnon

    1982-01-01

    Results of intravenous urography (IVU) in 33 patients suspected of suffering from renal trauma were reviewed. It was concluded that when haematuria is only detected microscopically and clears within 24 hr then an IVU is not necessary, in the absence of other evidence of significant urinary tract injury.

  3. CDX-1401 and Poly-ICLC Vaccine Therapy With or Without CDX-301in Treating Patients With Stage IIB-IV Melanoma

    ClinicalTrials.gov

    2015-01-19

    Carcinoma of Unknown Primary Origin; Iris Melanoma; Medium/Large Size Posterior Uveal Melanoma; Mucosal Melanoma; Ocular Melanoma With Extraocular Extension; Small Size Posterior Uveal Melanoma; Stage IIB Skin Melanoma; Stage IIB Uveal Melanoma; Stage IIC Skin Melanoma; Stage IIIA Skin Melanoma; Stage IIIA Uveal Melanoma; Stage IIIB Skin Melanoma; Stage IIIB Uveal Melanoma; Stage IIIC Skin Melanoma; Stage IIIC Uveal Melanoma; Stage IV Skin Melanoma; Stage IV Uveal Melanoma

  4. Intravenous immunoglobulin treatment for acute fulminant inflammatory cardiomyopathy: Series of six patients and review of literature

    PubMed Central

    Goland, Sorel; Czer, Lawrence SC; Siegel, Robert J; Tabak, Steven; Jordan, Stanley; Luthringer, Daniel; Mirocha, James; Coleman, Bernice; Kass, Robert M; Trento, Alfredo

    2008-01-01

    BACKGROUND: Although an autoimmune mechanism has been postulated for myocarditis and acute-onset inflammatory dilated cardiomyopathy (DCM), immunomodulatory treatment strategies are still under investigation. METHODS AND RESULTS: The clinical data of six patients with acute inflammatory DCM referred for evaluation for possible heart transplantation were reviewed. All patients were admitted with acute congestive heart failure and severely impaired left ventricular (LV) function and were treated with high-dose (2 g/kg) intravenous immunoglobulin (IVIG). The diagnosis of acute inflammatory DCM was based on recent onset of congestive heart failure (New York Heart Association functional class III or IV) with severely depressed LV ejection fraction ([LVEF] 30% or lower) occurring shortly after viral-like illness. All patients had inflammation on endomyocardial biopsy or elevated cardiac enzymes, as well as a normal coronary angiogram. All patients were in New York Heart Association class I or II at the time of hospital discharge. The mean LVEF improved from 21.7±7.5% at baseline to 50.3±8.6% at discharge (P=0.005). Four patients had complete recovery (LVEF 50% or higher) and two patients had partial LV recovery. Patients were followed for a median 13.2 months (range two to 24 months) and had a mean LVEF of 53±6% (P not significant versus LVEF at discharge). CONCLUSIONS: Therapy with intravenous high-dose IVIG may be a potentially useful treatment in selected patients if given early in the course of acute fulminant inflammatory DCM. A randomized, prospective trial is warranted to prove the real benefit of IVIG in this patient population. PMID:18612500

  5. Fluid therapy in calves.

    PubMed

    Smith, Geof W; Berchtold, Joachim

    2014-07-01

    Early and aggressive fluid therapy is critical in correcting the metabolic complications associated with calf diarrhea. Oral electrolyte therapy can be used with success in calves, but careful consideration should be given to the type of oral electrolyte used. Electrolyte solutions with high osmolalities can significantly slow abomasal emptying and can be a risk factor for abomasal bloat in calves. Milk should not be withheld from calves with diarrhea for more than 12 to 24 hours. Hypertonic saline and hypertonic sodium bicarbonate can be used effectively for intravenous fluid therapy on farms when intravenous catheterization is not possible. PMID:24980729

  6. Complications of cyclosporin therapy

    Microsoft Academic Search

    Barry D. Kahan; Stuart M. Flechner; Marc I. Lorber; Chris Jensen; Debbie Golden; Charles T. Van Buren

    1986-01-01

    Cyclosporin (CsA) therapy has improved the outcome of allotransplants. Because of a relatively selective action on T lymphocytes, CsA therapy causes fewer immunosuppressive complications of infection or malignancy compared to previous chemical agents, which were relatively nonspecific in their spectrum of action on lymphoid versus nonlymphoid cells. Gastrointestinal complaints after oral administration and vasomotor reactions after intravenous administration represent pharmacologic

  7. Intravenous ibandronate injections given every three months: a new treatment option to prevent bone loss in postmenopausal women

    PubMed Central

    Stakkestad, J; Benevolenskaya, L; Stepan, J; Skag, A; Nordby, A; Oefjord, E; Burdeska, A; Jonkanski, I; Mahoney, P

    2003-01-01

    Objective: To investigate the efficacy, safety, and dose response of three doses of ibandronate, given intermittently by intravenous (IV) injection every three months, in preventing postmenopausal osteoporosis. Patients and methods: 629 postmenopausal women, categorised according to time since menopause and baseline lumbar spine (L1–4) bone mineral density (BMD), were enrolled into a multicentre, double blind, placebo controlled trial. They were randomly allocated to receive IV ibandronate 0.5 mg, 1 mg or 2 mg, or placebo every three months. All women received daily calcium supplementation. Results: One year's treatment with intermittent IV ibandronate injections produced a dose dependent gain in mean (SD) lumbar spine BMD from baseline of 2.5 (2.5)%, 1.8 (2.6)%, and 1.0 (2.8)% in the groups receiving 2 mg, 1 mg, and 0.5 mg ibandronate, respectively, compared with a loss of BMD of 0.4 (2.4)% in the women in the placebo group; p=0.0001 for each ibandronate dose v placebo. Highest BMD gains occurred in women with osteopenia receiving 2 mg ibandronate. Similarly, at the hip, all three doses of ibandronate produced significantly better gains in BMD than placebo (p<0.05), with the greatest gains in the women with osteopenia receiving the 2 mg dose. Ibandronate concomitantly and dose dependently suppressed markers of bone turnover in comparison with placebo, and injections were well tolerated. Conclusion: IV ibandronate injections, given every three months, may be an effective alternative to oral bisphosphonates and hormonal therapy in the prevention of bone loss in postmenopausal women. PMID:12972476

  8. Influence of intravenously administered ciprofloxacin on aerobic intestinal microflora and fecal drug levels when administered simultaneously with sucralfate.

    PubMed

    Krueger, W A; Ruckdeschel, G; Unertl, K

    1997-08-01

    Ciprofloxacin, when given intravenously (i.v.), is secreted in significant amounts via the mucosa into the intestinal lumen. Sucralfate inhibits the antimicrobial activity of ciprofloxacin. The effect of combined therapy on the intestinal flora was investigated in 16 healthy volunteers. They were randomly assigned to two groups. Group A received 2 g of sucralfate orally three times a day for 7 days and 400 mg of ciprofloxacin i.v. twice a day (b.i.d.) starting 3 days after the sucralfate administration began. Group B was given only 400 mg of ciprofloxacin i.v. b.i.d. for 4 days. A total of 9 stool samples were collected from each subject beginning the week before ciprofloxacin was administered and on days -1, 1, 2, 3, 4, 7, 9, and 10 or 11 after commencement of the infusion period. The aerobic fecal flora was determined by standard microbiological methods. Measurements of fecal ciprofloxacin levels were based on high-performance liquid chromatography. Counts of bacteria of the family Enterobacteriaceae decreased in all subjects and were below 10(2) CFU/g in eight of eight subjects (group A) and six of eight subjects (group B) on day 4, but they returned to normal in all but one subject (group A) 10 days after the last infusion. The decreases in levels of bacteria of the family Enterobacteriaceae were not significantly different in groups A and B (Kaplan-Meier test). Staphylococci and nonfermenters responded variably, enterococci and lactobacilli remained unchanged, and candida levels increased transiently in four subjects (two in each group). Maximum fecal drug levels ranged from 251 to 811 microg/g. No significant difference could be found between the two groups. The i.v. application of ciprofloxacin eliminates intestinal bacteria of the family Enterobacteriaceae in a rapid and selective manner. This effect is not affected by simultaneous oral application of sucralfate. PMID:9257749

  9. Single intravenous and oral dose pharmacokinetics of florfenicol in the channel catfish Ictalurus punctatus

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Plasma distribution and elimination of florfenicol in channel catfish were investigated after a single dose (10mg/kg) of intravenous i.v.) or oral administration in freshwater at a mean water temperature of 25.4°C. Florfenicol concentrations in plasma were analyzed by means of liquid chromatography...

  10. Intravenous Ketorolac Tromethamine Does Not Worsen Platelet Function During Knee Arthroscopy Under General Anesthesia

    Microsoft Academic Search

    BRIAN K. THWAITES; DAREN B. NIGUS; GREGORY W. BOUSKA; PAUL D. MONGAN; ELEANOR F. AYALA; GERALD A. MERRILL

    1996-01-01

    function may be accentuated during the stress of gen- eral anesthesia (GA) and surgery. The purpose of this study was to investigate platelet function changes dur- ing a standard GA technique and surgery, as well as after a single intraoperative dose of intravenous (IV) KT. The study comprised 30 ASA physical status I pa- tients undergoing GA for knee arthroscopy.

  11. Investigation of the Clinical Efficacy and Dosage of Intravenous Ciprofloxacin in Patients with Respiratory Infection

    Microsoft Academic Search

    Kazuhiro Matsuo; Minako Azuma; Maki Kasai; Itsuka Hanji; Itsuki Kimura; Takayoshi Kosugi; Noriko Suga; Mitsutoshi Satoh

    2008-01-01

    Purpose. Multidrug-resistant Pseudo- monas aeruginosa (MDRP), which seems to be linked to antibiotics consumption, has become a significant problem. Infection control is of vital importance, hence, proper use of antimicrobial drugs is one of the most crucial roles of hospital pharmacists. In this study, we surveyed patients who had been prescribed intravenous (i.v.) ciprofloxacin (CPFX) as the only antibiotic, and

  12. Pharmacokinetics and tissue distribution of chlorpheniramine in rabbits after intravenous administration

    Microsoft Academic Search

    Shiew-Mei Huang; Win L. Chiou

    1981-01-01

    Intravenous studies of chlorpheniramine (CPM) were conducted in six New Zealand White male rabbits (mean wt. 3.88 kg). CPM and its two demethylated metabolites in arterial serum and urine were assayed by HPLC. Triexponential equations were needed to fit the i.V. CPM serum data in three rabbits, while biexponential equations were required in the other three rabbits. Harmonic mean of

  13. Brain distribution and behavioral effects of progesterone and pregnenolone after intranasal or intravenous administration

    Microsoft Academic Search

    Nicole Ducharme; William A. Banks; John E. Morley; Sandra M. Robinson; Michael L. Niehoff; Claudia Mattern

    2010-01-01

    Neurosteroids hold great promise for the treatment of diseases of the central nervous system (CNS). We compared the uptake by 11 brain regions and appearance in blood of tritium-labeled pregnenolone and progesterone after intranasal and intravenous (IV) injection. Both neurosteroids appeared in blood and brain after either method of administration, but with important differences in uptake. Bioavailability based on appearance

  14. Response to intravenous immunoglobulin treatment in chronic inflammatory demyelinating polyneuropathy with only sensory symptoms

    Microsoft Academic Search

    G. W. van Dijk; N. C. Notermans; H. Franssen; P. L. Oey; J. H. J. Wokke

    1996-01-01

    In an open prospective study we analysed the effect of treatment with intravenous immunoglobulin (IvIg) in three patients with clinically pure sensory neuropathy, two of whom met the clinical, electrophysiological, pathological and cerebrospinal fluid research criteria of the American Academy of Neurology for chronic inflammatory demyelinating polyneuropathy. In all patients, subclinical signs of de myelination were present in motor nerves.

  15. Phase I study of intermittent intravenous bromodeoxyuridine (BUdR) with conventional fractionated irradiation

    Microsoft Academic Search

    Timothy J. Kinsella; Angelo Russo; James B. Mitchell; Janet Rowland; Jean Jenkins; James Schwade; Charles E. Myers; Jerry M. Collins; James Speyer; M. D. Kornblith

    1984-01-01

    A Phase I trial of intravenous bromodeoxyuridine (BUdR) and conventional fractionated radiation therapy was performed in 14 patients with glioblastoma multiforme and 7 patients with other poorly radioresponsive tumors. The BUdR was given as a constant intravenous infusion for 12 hr\\/day for up to 14 days. Local toxicity (within the radiation field) was minor, with 7 of the 21 patients

  16. A comparison between intravenous paracetamol plus fentanyl and intravenous fentanyl alone for postoperative analgesia during laparoscopic cholecystectomy

    PubMed Central

    Choudhuri, Anirban Hom; Uppal, Rajeev

    2011-01-01

    Purpose: our study compared the effect of fentanyl alone with fentanyl plus intravenous Paracetamol for analgesic efficacy, opioid sparing effects, and opioid-related side effects after laparoscopic cholecystectomy. Materials and Methods: eighty patients undergoing laparoscopic cholecystectomy were randomized into two groups, who were given either an IV placebo or an IV injection of 1g paracetamol just before induction. Both groups received fentanyl during induction and IM diclofenac for pain relief every 8 hourly for 24 h after surgery. The postoperative pain relief was evaluated by a visual analog scale (VAS) and consumption of fentanyl as rescue analgesic in the postoperative period for 24 h after surgery was measured. The incidence of PONV and sedation scores was also measured in the postoperative period. Results: the mean VAS score in first and second hour after surgery was less in the group receiving IV Paracetamol (3.3±0.4* vs. 5.2±0.9; 3.1±0.4* vs. 4.3±0.3); the fentanyl consumption over first 24 h was also less in the group receiving IV paracetamol (50±14.9 vs. 150±25.8). The time requirement of first dose of rescue analgesic in the postoperative period was also significantly prolonged in the group receiving IV paracetamol (76±24.7 vs. 48±15.8). There was no difference in the sedation scores and in the incidence of PONV in the two groups. Conclusion: The study demonstrates the usefulness of intravenous paracetamol as pre-emptive analgesic in the treatment of postoperative pain after laparoscopic cholecystectomy. PMID:25885388

  17. Home intravenous antibiotic treatment in cystic fibrosis

    Microsoft Academic Search

    J Gilbert; T Robinson; J M Littlewood

    1988-01-01

    The prognosis for patients with cystic fibrosis who are colonised with Pseudomonas aeruginosa has improved as a result of the regular use of intravenous antibiotics; however, this necessitates long periods of hospitalisation. Home intravenous antibiotic treatment has potential advantages over hospital treatment. We describe our experience during the first 20 months of using a system of home intravenous antibiotic treatment

  18. Type IV Bartter syndrome: report of two new cases.

    PubMed

    Zaffanello, Marco; Taranta, Anna; Palma, Alessia; Bettinelli, Alberto; Marseglia, Gian Luigi; Emma, Francesco

    2006-06-01

    Bartter syndrome with sensorineural deafness (type IV Bartter syndrome) is a subtype of this tubular disease, and is due to mutations in the BSND gene. Out of a population of 92 patients with Bartter syndrome, five suffered from mild to severe hypoacusia and were selected for mutational screening. A homozygous mutation in the BSND gene was found in two female patients. The first patient was found to have a substitution in intron 1 donor splice site at position +5 (c.420+5G>C), whereas the second patient has a homozygous 3G>A substitution leading to the loss of the start codon for the translation of the BSND mRNA. The clinical courses of these two patients were remarkable for severe polyhydramnios, massive renal salt and water wasting, severe neonatal hypotonia, poor growth and unresponsiveness to prostaglandin inhibitors. The diuretic responses to furosemide and to hydrochlorothiazide were tested under KCl supplementation in one patient. A lack of response to both drugs suggested that inhibition of NaCl reabsorption in type IV Bartter syndrome is not restricted to the thick ascending limb of Henle. In one patient, a combined therapy with indomethacin and captopril was needed to discontinue intravenous fluids and improve weight gain. PMID:16583241

  19. Vaccine Therapy and Cyclophosphamide in Treating Patients With Stage II-III Breast or Stage II-IV Ovarian, Primary Peritoneal, or Fallopian Tube Cancer

    ClinicalTrials.gov

    2014-11-20

    Recurrent Breast Cancer; Recurrent Fallopian Tube Cancer; Recurrent Ovarian Epithelial Cancer; Recurrent Primary Peritoneal Cavity Cancer; Stage II Breast Cancer; Stage IIA Breast Cancer; Stage IIA Fallopian Tube Cancer; Stage IIA Ovarian Epithelial Cancer; Stage IIA Primary Peritoneal Cavity Cancer; Stage IIB Breast Cancer; Stage IIB Fallopian Tube Cancer; Stage IIB Ovarian Epithelial Cancer; Stage IIB Primary Peritoneal Cavity Cancer; Stage IIC Fallopian Tube Cancer; Stage IIC Ovarian Epithelial Cancer; Stage IIC Primary Peritoneal Cavity Cancer; Stage IIIA Breast Cancer; Stage IIIA Fallopian Tube Cancer; Stage IIIA Ovarian Epithelial Cancer; Stage IIIA Primary Peritoneal Cavity Cancer; Stage IIIB Breast Cancer; Stage IIIB Fallopian Tube Cancer; Stage IIIB Ovarian Epithelial Cancer; Stage IIIB Primary Peritoneal Cavity Cancer; Stage IIIC Breast Cancer; Stage IIIC Fallopian Tube Cancer; Stage IIIC Ovarian Epithelial Cancer; Stage IIIC Primary Peritoneal Cavity Cancer; Stage IV Fallopian Tube Cancer; Stage IV Ovarian Epithelial Cancer; Stage IV Primary Peritoneal Cavity Cancer

  20. Sirolimus and Vaccine Therapy in Treating Patients With Stage II-IV Ovarian Epithelial, Fallopian Tube, or Primary Peritoneal Cavity Cancer

    ClinicalTrials.gov

    2014-11-10

    Recurrent Fallopian Tube Cancer; Recurrent Ovarian Epithelial Cancer; Recurrent Primary Peritoneal Cavity Cancer; Stage IIA Fallopian Tube Cancer; Stage IIA Ovarian Epithelial Cancer; Stage IIA Primary Peritoneal Cavity Cancer; Stage IIB Fallopian Tube Cancer; Stage IIB Ovarian Epithelial Cancer; Stage IIB Primary Peritoneal Cavity Cancer; Stage IIC Fallopian Tube Cancer; Stage IIC Ovarian Epithelial Cancer; Stage IIC Primary Peritoneal Cavity Cancer; Stage IIIA Fallopian Tube Cancer; Stage IIIA Ovarian Epithelial Cancer; Stage IIIA Primary Peritoneal Cavity Cancer; Stage IIIB Fallopian Tube Cancer; Stage IIIB Ovarian Epithelial Cancer; Stage IIIB Primary Peritoneal Cavity Cancer; Stage IIIC Fallopian Tube Cancer; Stage IIIC Ovarian Epithelial Cancer; Stage IIIC Primary Peritoneal Cavity Cancer; Stage IV Fallopian Tube Cancer; Stage IV Ovarian Epithelial Cancer; Stage IV Primary Peritoneal Cavity Cancer

  1. Intravenous magnetic nanoparticle cancer hyperthermia

    PubMed Central

    Huang, Hui S; Hainfeld, James F

    2013-01-01

    Magnetic nanoparticles heated by an alternating magnetic field could be used to treat cancers, either alone or in combination with radiotherapy or chemotherapy. However, direct intratumoral injections suffer from tumor incongruence and invasiveness, typically leaving undertreated regions, which lead to cancer regrowth. Intravenous injection more faithfully loads tumors, but, so far, it has been difficult achieving the necessary concentration in tumors before systemic toxicity occurs. Here, we describe use of a magnetic nanoparticle that, with a well-tolerated intravenous dose, achieved a tumor concentration of 1.9 mg Fe/g tumor in a subcutaneous squamous cell carcinoma mouse model, with a tumor to non-tumor ratio > 16. With an applied field of 38 kA/m at 980 kHz, tumors could be heated to 60°C in 2 minutes, durably ablating them with millimeter (mm) precision, leaving surrounding tissue intact. PMID:23901270

  2. Complications of Intravenous Regional Anesthesia

    Microsoft Academic Search

    Dominic A. Cave; Barry A. Finegan

    Intravenous regional anesthesia (IVRA) of the limb was first described by Bier in 1908.1 The original technique involved the surgical exposure of, and direct injection of local anesthetic into, an antecubital vessel,\\u000a of an exsanguinated and isolated upper limb, thereby rendering the tissue below the applied tourniquet insensitive to pain.\\u000a IVRA is a simple and effective method of providing anesthesia

  3. Intravenous Regional Anesthesia with Meperidine

    Microsoft Academic Search

    Iurie Acalovschi; Tudor Cristea

    1995-01-01

    Forty-five ASA physical status I volunteers, divided in three groups of 15 each, received intravenous regional anesthesia (IVRA) of the upper limb with 40 mL meper- idine 0.25%, lidocaine 0.5%, or 0.9% sodium chloride (isolated ischemia) by random allocation. Using a dou- ble-blind method, the onset and recovery of sensory block was tested at six sites of the forearm and

  4. Impact of intravenous nitroglycerin in the management of acute decompensated heart failure.

    PubMed

    den Uil, Corstiaan A; Brugts, Jasper J

    2015-02-01

    Intravenous nitroglycerin is a well-known, but underused, treatment for acute decompensated heart failure. Nitroglycerin has a rapid onset of action and short half-life and there is a clear dose-response curve on both global hemodynamics and peripheral circulation. IV nitroglycerin reduces LV and RV filling pressures and afterload. In the case of acute decompensated heart failure, there is a typical decreased bioavailability of nitric oxide (NO), which needs to be supplemented by exogenous nitrates. Additionally, there is benefit on clinical endpoints, such as fast optimization of arterial oxygenation, lower rates of mechanical ventilation, and improved survival. Drawbacks of therapy include not only side effects such as headache, resistance, and development of tolerability to nitrates but also free radical production. However, nitrates in combination with diuretics remain the cornerstone of acute decompensated heart failure treatment. We propose a more aggressive use of nitrates and a more limited use of inotropes (due to ischemic demand and pro-arrhythmogenic characteristics) in normo- or hypertensive patients with acute heart failure. PMID:25301529

  5. Best Practice for Fever Management With Intravenous Acetaminophen in Pediatric Oncology.

    PubMed

    Dokko, Dorothy

    2014-07-18

    Intravenous (IV) acetaminophen was introduced in the United States in 2011 for use as an analgesic and antipyretic agent. While no studies have looked at its utilization specifically in the pediatric oncology population, existing literature suggests IV acetaminophen is safe and effective to use in both children and adults. This article aims to review and apply current data in evaluating whether or not children with cancer can safely benefit from its use. This article provides clinical indications, safety and efficacy profiles, and nursing implications along with recommendations for future study regarding the use of IV acetaminophen in this population. PMID:25037174

  6. Infected pseudoaneurysms in intravenous drug abusers: Ligation or reconstruction?

    PubMed Central

    Saini, Navdeep Singh; Luther, Anil; Mahajan, Amit; Joseph, Allen

    2014-01-01

    Background: Infected pseudoaneurysm in intravenous (IV) drug abusers is a serious clinical problem, with difficult and controversial management. With existing controversies regarding their optimal management, we present the results of simple ligation and local debridement for treatment of infected pseudoaneurysms. Patients and Methods: Records of 72 consecutive patients with pseudoaneurysms in IV drug abusers over the last 20 years were reviewed retrospectively. Results: Ligation and excision of pseudoaneurysm was done in all patients with delayed revascularization in only two patients. Four patients had amputations because they had gangrenous limbs on presentation. All other patients had healthy limbs at the time of discharge. There were three deaths, two due to sepsis with multiorgan dysfunction and one with hemorrhagic shock. Conclusion: Infected pseudoaneurysm should be managed by simple ligation of involved artery with delayed revascularization, if required. PMID:25298938

  7. Effects of Hypnosis as an Adjunct to Intravenous Sedation for Third Molar Extraction: A Randomized, Blind, Controlled Study

    Microsoft Academic Search

    Edward F. Mackey

    2009-01-01

    The effects of hypnosis\\/therapeutic suggestion in connection with intravenous sedation and surgery have been described in many clinical publications; however, few randomized, controlled, and blind studies have been performed in the outpatient area. This study aimed to evaluate the use of hypnosis\\/therapeutic suggestion as an adjunct to intravenous (IV) sedation in patients having 3rd molar removal in an outpatient setting.

  8. Intravenous lidocaine and magnesium for management of intractable trigeminal neuralgia: a case series of nine patients.

    PubMed

    Arai, Young-Chang P; Hatakeyama, Noboru; Nishihara, Makoto; Ikeuchi, Masahiko; Kurisuno, Makoto; Ikemoto, Tatsunori

    2013-12-01

    Most patients suffering from trigeminal neuralgia (TN) benefit from medical therapy, for example carbamazepin, gabapentin, and pregabalin, individually or in combination. Nonetheless, some patients experience severe and intractable pain despite such medication, or the medication eliminates their pain but they experience intolerable side effects sufficient to warrant discontinuation. Intravenous magnesium and lidocaine have been used for management of intractable neuropathic pain. We treated nine patients with TN by using an intravenous infusion of a combination of 1.2 g magnesium and 100 mg lidocaine for 1 hour, once a week for 3 weeks. All patients experienced sound pain relief after the combined intravenous infusion therapy. Two patients experienced short and mild dizziness after the therapy, but no severe side effects were reported. PMID:23712613

  9. Docetaxel With Either Cetuximab or Bortezomib as First-Line Therapy in Treating Patients With Stage III or Stage IV Non-Small Cell Lung Cancer

    ClinicalTrials.gov

    2013-06-03

    Adenocarcinoma of the Lung; Adenosquamous Cell Lung Cancer; Large Cell Lung Cancer; Malignant Pleural Effusion; Recurrent Non-small Cell Lung Cancer; Squamous Cell Lung Cancer; Stage IIIB Non-small Cell Lung Cancer; Stage IV Non-small Cell Lung Cancer

  10. PET-Adjusted Intensity Modulated Radiation Therapy and Combination Chemotherapy in Treating Patients With Stage II-IV Non-small Cell Lung Cancer

    ClinicalTrials.gov

    2015-01-14

    Recurrent Non-Small Cell Lung Carcinoma; Stage IIA Non-Small Cell Lung Carcinoma; Stage IIB Non-Small Cell Lung Carcinoma; Stage IIIA Non-Small Cell Lung Cancer; Stage IIIB Non-Small Cell Lung Cancer; Stage IV Non-Small Cell Lung Cancer

  11. Immediate relief of Mycoplasma pneumoniae encephalitis symptoms after intravenous immunoglobulin.

    PubMed

    Chambert-Loir, Caroline; Ouachee, Marie; Collins, Kevin; Evrard, Philippe; Servais, Laurent

    2009-11-01

    Mycoplasma pneumoniae may cause acute encephalitis, resulting in severe neurologic complications despite antibiotic therapy. We report the case of a 12-year-old patient who presented with acute onset of orofacial tics, motor restlessness, compulsive behavior, and cerebellar symptoms. Cerebrospinal fluid examination demonstrated lymphocytic meningitis. Polymerase chain reaction for M. pneumoniae was strongly positive in the cerebrospinal fluid. Blood and cerebrospinal fluid were negative for M. pneumoniae antibodies (immunoglobulin M and immunoglobulin G). The child was administered intravenous gamma-globulin, which led to a dramatic improvement of her clinical condition and disappearance of the symptoms within 72 hours. This novel case points to the potential value of gamma-globulin in M. pneumoniae encephalitis confirmed with polymerase chain reaction and suggests that immediate administration of intravenous gamma-globulin in suspected mycoplasma encephalitis should be investigated in a larger patient cohort. PMID:19818942

  12. Exporting simulation technology to the Philippines: a comparative study of traditional versus simulation methods for teaching intravenous cannulation.

    PubMed

    Sotto, Juan Alejandro R; Ayuste, Eduardo C; Bowyer, Mark W; Almonte, Josefina R; Dofitas, Rodney B; Lapitan, Marie C M; Pimentel, Elisabeth A; Ritter, E Matthew; Wherry, David C

    2009-01-01

    This study examines effectiveness of a donated Laerdal Virtual I.V. simulator when compared with traditional methods of teaching intravenous (IV) cannulation to third year medical students in the Philippines. Forty novice Filipino medical students viewed an instructional video on how to start intravenous lines and were then randomly divided into two groups of twenty. The "Traditional" group observed an IV insertion on an actual patient performed by an experienced practitioner, and then subsequently performed an IV on an actual patient which was videotaped. The "Simulation" group practiced the Virtual I.V. simulator until they successfully completed level three using the "doctor" setting. These students then performed an IV on an actual patient which was videotaped. The videotapes for both groups were reviewed by two pre-trained (Inter-rater reliability of > or =0.84) observers who were blinded to the group using a previously validated checklist for IV insertion. Students trained on the Virtual I.V. showed significantly greater success in successfully starting an IV on an actual patient (40% VS. 15%, p<0.05), decreased constrictive band time (p<.05), increased raw score on the check list (p<.03), and decreased overall time to start an IV (p<.05). The technology was well received but wider application in the non western world is limited by lack of in country company support and the relative expense. PMID:19377182

  13. Advances in Intravenous Lipid Emulsions

    Microsoft Academic Search

    2000-01-01

    Over the past decade, our views have\\u000a considerably evolved with respect to the metabolism of intravenous\\u000a lipid emulsions and their composition. Substantial progress has been\\u000a made in understanding the metabolic pathways of emulsion particles and\\u000a the delivery of their various components (fatty acids and vitamins) to\\u000a specific tissues or cells. Although soybean long-chain triglycerides\\u000a represent a valuable source of energy,

  14. Paclitaxel and Carboplatin Before Radiation Therapy With Paclitaxel in Treating HPV-Positive Patients With Stage III-IV Oropharynx, Hypopharynx, or Larynx Cancer

    ClinicalTrials.gov

    2014-09-08

    Human Papilloma Virus Infection; Stage III Squamous Cell Carcinoma of the Hypopharynx; Stage III Squamous Cell Carcinoma of the Larynx; Stage III Squamous Cell Carcinoma of the Oropharynx; Stage III Verrucous Carcinoma of the Larynx; Stage IV Squamous Cell Carcinoma of the Hypopharynx; Stage IV Verrucous Carcinoma of the Larynx; Stage IVA Squamous Cell Carcinoma of the Larynx; Stage IVA Squamous Cell Carcinoma of the Oropharynx; Stage IVA Verrucous Carcinoma of the Larynx; Stage IVB Squamous Cell Carcinoma of the Larynx; Stage IVB Squamous Cell Carcinoma of the Oropharynx; Stage IVB Verrucous Carcinoma of the Larynx; Stage IVC Squamous Cell Carcinoma of the Larynx; Stage IVC Squamous Cell Carcinoma of the Oropharynx; Stage IVC Verrucous Carcinoma of the Larynx

  15. Stroke Code Improves Intravenous Thrombolysis Administration in Acute Ischemic Stroke

    PubMed Central

    Chen, Chih-Hao; Tang, Sung-Chun; Tsai, Li-Kai; Hsieh, Ming-Ju; Yeh, Shin-Joe; Huang, Kuang-Yu; Jeng, Jiann-Shing

    2014-01-01

    Background and Purpose Timely intravenous (IV) thrombolysis for acute ischemic stroke is associated with better clinical outcomes. Acute stroke care implemented with “Stroke Code” (SC) may increase IV tissue plasminogen activator (tPA) administration. The present study aimed to investigate the impact of SC on thrombolysis. Methods The study period was divided into the “pre-SC era” (January 2006 to July 2010) and “SC era” (August 2010 to July 2013). Demographics, critical times (stroke symptom onset, presentation to the emergency department, neuroimaging, thrombolysis), stroke severity, and clinical outcomes were recorded and compared between the two eras. Results During the study period, 5957 patients with acute ischemic stroke were admitted; of these, 1301 (21.8%) arrived at the emergency department within 3 h of stroke onset and 307 (5.2%) received IV-tPA. The number and frequency of IV-tPA treatments for patients with an onset-to-door time of <3 h increased from the pre-SC era (n?=?91, 13.9%) to the SC era (n?=?216, 33.3%) (P<0.001). SC also improved the efficiency of IV-tPA administration; the median door-to-needle time decreased (88 to 51 min, P<0.001) and the percentage of door-to-needle times ?60 min increased (14.3% to 71.3%, P<0.001). The SC era group tended to have more patients with good outcome (modified Rankin Scale ?2) at discharge (49.5 vs. 39.6%, P?=?0.11), with no difference in symptomatic hemorrhage events or in-hospital mortality. Conclusion The SC protocol increases the percentage of acute ischemic stroke patients receiving IV-tPA and decreases door-to-needle time. PMID:25111200

  16. Catheter indwell time and phlebitis development during peripheral intravenous catheter administration

    PubMed Central

    Pasalioglu, Kadriye Burcu; Kaya, Hatice

    2014-01-01

    Objective: Intravenous catheters have been indispensable tools of modern medicine. Although intravenous applications can be used for a multitude of purposes, these applications may cause complications, some of which have serious effects. Of these complications, the most commonly observed is phlebitis. This study was conducted to determine the effect of catheter indwell time on phlebitis development during peripheral intravenous catheter administration. Methods: This study determined the effect of catheter indwell time on phlebitis development during peripheral intravenous catheter administration. The study included a total of 103 individuals who were administered 439 catheters and satisfied the study enrollment criteria at one infectious diseases clinic in Istanbul/Turkey. Data were compiled from Patient Information Forms, Peripheral Intravenous Catheter and Therapy Information Forms, reported grades based on the Visual Infusion Phlebitis Assessment Scale, and Peripheral Intravenous Catheter Nurse Observation Forms. The data were analyzed using SPSS. Results : The mean patient age was 53.75±15.54 (standard deviation) years, and 59.2% of the study participants were men. Phlebitis was detected in 41.2% of peripheral intravenous catheters, and the rate decreased with increased catheter indwell time. Analyses showed that catheter indwell time, antibiotic usage, sex, and catheterization sites were significantly associated with development of phlebitis. Conclusion: The results of this study show that catheters can be used for longer periods of time when administered under optimal conditions and with appropriate surveillance. PMID:25097505

  17. Welding IV.

    ERIC Educational Resources Information Center

    Allegheny County Community Coll., Pittsburgh, PA.

    Instructional objectives and performance requirements are outlined in this course guide for Welding IV, a competency-based course in advanced arc welding offered at the Community College of Allegheny County to provide students with proficiency in: (1) single vee groove welding using code specifications established by the American Welding Society…

  18. Effect of Continuous and Discontinuous Intravenous or Intragastric Total Parenteral Nutrition in Rats on Serum Lipids, Liver Lipids and Liver Lipogenic Rates1-2

    Microsoft Academic Search

    SUSAN LANZA-JACOBY

    Lipogenesis and evidence of fat accumulation in the liver were inves tigated in adult male rats fed a Hypertonie dextrose diet by continuous (C) and discon tinuous (D) intravenous (IV) or intragastric (IG) infusion for 14 d. Rats fed by the IV and IG route were infused continuously and discontinuously (2100-0900) with 55 ml\\/d of a solution containing 30% dextrose

  19. Local iontophoretic administration of cytotoxic therapies to solid tumors.

    PubMed

    Byrne, James D; Jajja, Mohammad R N; O'Neill, Adrian T; Bickford, Lissett R; Keeler, Amanda W; Hyder, Nabeel; Wagner, Kyle; Deal, Allison; Little, Ryan E; Moffitt, Richard A; Stack, Colleen; Nelson, Meredith; Brooks, Christopher R; Lee, William; Luft, J Chris; Napier, Mary E; Darr, David; Anders, Carey K; Stack, Richard; Tepper, Joel E; Wang, Andrew Z; Zamboni, William C; Yeh, Jen Jen; DeSimone, Joseph M

    2015-02-01

    Parenteral and oral routes have been the traditional methods of administering cytotoxic agents to cancer patients. Unfortunately, the maximum potential effect of these cytotoxic agents has been limited because of systemic toxicity and poor tumor perfusion. In an attempt to improve the efficacy of cytotoxic agents while mitigating their side effects, we have developed modalities for the localized iontophoretic delivery of cytotoxic agents. These iontophoretic devices were designed to be implanted proximal to the tumor with external control of power and drug flow. Three distinct orthotopic mouse models of cancer and a canine model were evaluated for device efficacy and toxicity. Orthotopic patient-derived pancreatic cancer xenografts treated biweekly with gemcitabine via the device for 7 weeks experienced a mean log2 fold change in tumor volume of -0.8 compared to a mean log2 fold change in tumor volume of 1.1 for intravenous (IV) gemcitabine, 3.0 for IV saline, and 2.6 for device saline groups. The weekly coadministration of systemic cisplatin therapy and transdermal device cisplatin therapy significantly increased tumor growth inhibition and doubled the survival in two aggressive orthotopic models of breast cancer. The addition of radiotherapy to this treatment further extended survival. Device delivery of gemcitabine in dogs resulted in more than 7-fold difference in local drug concentrations and 25-fold lower systemic drug levels than the IV treatment. Overall, these devices have potential paradigm shifting implications for the treatment of pancreatic, breast, and other solid tumors. PMID:25653220

  20. Intravenous Patient-controlled Analgesia Has a Positive Effect on the Prognosis of Delirium in Patients Undergoing Orthopedic Surgery

    PubMed Central

    Heo, Dae Young

    2014-01-01

    Background Postoperative delirium is relatively common. However, the relationship between intravenous patient-controlled analgesia (IV-PCA) and delirium has not been thoroughly investigated. The aim of this study was to evaluate the effects of IV-PCA on the prognosis of postoperative delirium in patients undergoing orthopedic surgery. Methods Medical records of 129 patients with postoperative delirium were reviewed. Patients were divided into two groups according to whether they used IV-PCA with fentanyl and ketorolac. The IV-PCA group consisted of 73 patients who were managed with IV-PCA; the NO-PCA group consisted of 56 patients who were managed without PCA. Results Incidences of multiple psychiatric consultations and prolonged delirium were significantly lower in patients using IV-PCA with fentanyl and ketorolac than in those without PCA. Conclusions We recommend the use of IV-PCA for pain control and management of delirium in patients with postoperative delirium. PMID:25031814

  1. Clinical Outcomes and Prognostic Factors of Empirical Antifungal Therapy with Itraconazole in the Patients with Hematological Malignancies: A Prospective Multicenter Observational Study in Korea

    PubMed Central

    Kim, Jin Seok; Cheong, June-Won; Shin, Ho Jin; Lee, Jong Wook; Lee, Je-Hwan; Yang, Deok-Hwan; Lee, Won Sik; Kim, Hawk; Park, Joon Seong; Kim, Sung-Hyun; Kim, Yang Soo; Kwak, Jae-Yong; Chae, Yee Soo; Park, Jinny; Do, Young Rok

    2014-01-01

    Purpose To identify prognostic factors for the outcomes of empirical antifungal therapy, we performed a multicenter, prospective, observational study in immunocompromised patients with hematological malignancies. Materials and Methods Three hundred seventy-six patients (median age of 48) who had neutropenic fever and who received intravenous (IV) itraconazole as an empirical antifungal therapy for 3 or more days were analyzed. The patients with possible or probable categories of invasive fungal disease (IFD) were enrolled. Results The overall success rate was 51.3% (196/376). Age >50 years, underlying lung disease (co-morbidity), poor performance status [Eastern Cooperative Oncology Group (ECOG) ?2], radiologic evidence of IFD, longer duration of baseline neutropenic fever (?4 days), no antifungal prophylaxis or prophylactic use of antifungal agents other than itraconazole, and high tumor burden were associated with decreased success rate in univariate analysis. In multivariate analysis, age >50 years (p=0.009) and poor ECOG performance status (p=0.005) were significantly associated with poor outcomes of empirical antifungal therapy. Twenty-two patients (5.9%) discontinued itraconazole therapy due to toxicity. Conclusion We concluded that empirical antifungal therapy with IV itraconazole in immunocompromised patients is effective and safe. Additionally, age over 50 years and poor performance status were poor prognostic factors for the outcomes of empirical antifungal therapy with IV itraconazole. PMID:24339281

  2. Triple antiplatelet therapy for preventing vascular events: a systematic review and meta-analysis

    PubMed Central

    2010-01-01

    Background Dual antiplatelet therapy is usually superior to mono therapy in preventing recurrent vascular events (VEs). This systematic review assesses the safety and efficacy of triple antiplatelet therapy in comparison with dual therapy in reducing recurrent vascular events. Methods Completed randomized controlled trials investigating the effect of triple versus dual antiplatelet therapy in patients with ischaemic heart disease (IHD), cerebrovascular disease or peripheral vascular disease were identified using electronic bibliographic searches. Data were extracted on composite VEs, myocardial infarction (MI), stroke, death and bleeding and analysed with Cochrane Review Manager software. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using random effects models. Results Twenty-five completed randomized trials (17,383 patients with IHD) were included which involving the use of intravenous (iv) GP IIb/IIIa inhibitors (abciximab, eptifibatide, tirofiban), aspirin, clopidogrel and/or cilostazol. In comparison with aspirin-based therapy, triple therapy using an intravenous GP IIb/IIIa inhibitor significantly reduced composite VEs and MI in patients with non-ST elevation acute coronary syndromes (NSTE-ACS) (VE: OR 0.69, 95% CI 0.55-0.86; MI: OR 0.70, 95% CI 0.56-0.88) and ST elevation myocardial infarction (STEMI) (VE: OR 0.39, 95% CI 0.30-0.51; MI: OR 0.26, 95% CI 0.17-0.38). A significant reduction in death was also noted in STEMI patients treated with GP IIb/IIIa based triple therapy (OR 0.69, 95% CI 0.49-0.99). Increased minor bleeding was noted in STEMI and elective percutaneous coronary intervention (PCI) patients treated with GP IIb/IIIa based triple therapy. Stroke events were too infrequent for us to be able to identify meaningful trends and no data were available for patients recruited into trials on the basis of stroke or peripheral vascular disease. Conclusions Triple antiplatelet therapy based on iv GPIIb/IIIa inhibitors was more effective than aspirin-based dual therapy in reducing VEs in patients with acute coronary syndromes (STEMI and NSTEMI). Minor bleeding was increased among STEMI and elective PCI patients treated with a GP IIb/IIIa based triple therapy. In patients undergoing elective PCI, triple therapy had no beneficial effect and was associated with an 80% increase in transfusions and an eightfold increase in thrombocytopenia. Insufficient data exist for patients with prior ischaemic stroke and peripheral vascular disease and further research is needed in these groups of patients. PMID:20553581

  3. Oral versus intravenous antibiotics for patients with Klebsiella pneumoniae liver abscess: study protocol for a randomized controlled trial

    PubMed Central

    2013-01-01

    Background Klebsiella pneumoniae liver abscess is the most common etiology of liver abscess in Singapore and much of Asia, and its incidence is increasing. Current management includes prolonged intravenous antibiotic therapy, but there is limited evidence to guide oral conversion. The implicated K1/K2 capsule strain of Klebsiella pneumoniae is almost universally susceptible to ciprofloxacin, an antibiotic with high oral bioavailability. Our primary aim is to compare the efficacy of early (< one week) step-down to oral antibiotics, to continuing four weeks of intravenous antibiotics, in patients with Klebsiella liver abscess. Methods/design The study is designed as a multi-center randomized open-label active comparator-controlled non-inferiority trial, with a non-inferiority margin of 12%. Eligible participants will be inpatients over the age of 21 with a CT or ultrasound scan suggestive of a liver abscess, and Klebsiella pneumoniae isolated from abscess fluid or blood. Randomization into intervention or active control arms will be performed with a 1:1 allocation ratio. Participants randomized to active control will receive IV ceftriaxone 2 grams daily to complete a total of four weeks of IV antibiotics. Participants randomized to intervention will be immediately converted to oral ciprofloxacin 750 mg twice daily. At Week four, all participants will undergo abdominal imaging and be assessed for clinical response (CRP?IV antibiotics. Discussion Our results would help inform local and international practice guidelines regarding the optimal antibiotic management of Klebsiella liver abscess. A finding of non-inferiority may translate to the wider adoption of a more cost-effective strategy that reduces hospital length of stay and improves patient-centered outcomes and satisfaction. Trial registration Clinical trials gov NCT01723150 PMID:24176222

  4. Unexplained abdominal pain as a driver for inappropriate therapeutics: an audit on the use of intravenous proton pump inhibitors

    PubMed Central

    Wong, Yin Yen; Low, Yong Chia; Lau, Hui Ling; Chin, Kin-Fah; Mahadeva, Sanjiv

    2014-01-01

    Background. Proton pump inhibitors (PPIs) are currently the most effective agents for acid-related disorders. However, studies show that 25–75% of patients receiving intravenous PPIs had no appropriate justification, indicating high rates of inappropriate prescribing. Objective. To examine the appropriate use of intravenous PPIs in accordance with guidelines and the efficacy of a prescribing awareness intervention at an Asian teaching institution. Setting. Prospective audit in a tertiary hospital in Malaysia. Method. Every 4th intravenous PPI prescription received in the pharmacy was screened against hospital guidelines. Interventions for incorrect indication/dose/duration were performed. Patients’ demographic data, medical history and the use of intravenous PPI were collected. Included were all adult inpatients prescribed intravenous PPI. Main Outcome Measure. Proportion of appropriate IV PPI prescriptions. Results. Data for 106 patients were collected. Most patients were male [65(61.3%)], Chinese [50(47.2%)], with mean age ± SD = 60.3 ± 18.0 years. Most intravenous PPI prescriptions were initiated by junior doctors from the surgical [47(44.3%)] and medical [42(39.6%)] departments. Only 50/106(47.2%) patients had upper gastrointestinal endoscopy/surgery performed to verify the source of bleeding. Unexplained abdominal pain [81(76.4%)] was the main driver for prescribing intravenous PPIs empirically, out of which 73(68.9%) were for suspected upper gastrointestinal bleed. Overall, intravenous PPI was found to be inappropriately prescribed in 56(52.8%) patients for indication, dose or duration. Interventions on the use of intravenous PPI were most effective when performed by senior doctors (100%), followed by clinical pharmacists (50%), and inpatient pharmacists (37.5%, p = 0.027). Conclusion. Inappropriate intravenous PPI usage is still prevalent despite the enforcement of hospital guidelines. The promotion of prescribing awareness and evidence-based prescribing through education of medical staff could result in more judicious use of intravenous PPI and dose-optimization. PMID:25024919

  5. Cerebral infarction 3 weeks after intravenous immunoglobulin for Miller Fisher syndrome: a case report

    PubMed Central

    2014-01-01

    Introduction Intravenous immunoglobulin is considered generally safe and is used widely as proven, and sometimes empiric, treatment for an expanding list of autoimmune diseases. Thromboembolic complications following intravenous immunoglobulin therapy are rare and there have been only five previous reports of stroke occurring within 2 to 10 days of infusion. This is the first report of cerebral infarction occurring after a longer latency of 3 weeks following intravenous immunoglobulin therapy in a patient presenting with Miller Fisher syndrome. Case presentation A previously well, 44-year-old Sri Lankan man progressively developed ophthalmoplegia, facial paralysis, ataxia and areflexia with neurophysiological and cerebrospinal fluid evidence consistent with the Miller Fisher syndrome. He made an unremarkable recovery with intravenous immunoglobulin therapy (0.4g/kg/day for 5 days, total 180g), but developed a cerebral infarct with haemorrhagic transformation 25 days later. He was noted to have a low blood pressure. Extensive investigations ruled out vasculopathic, embolic, thrombophilic and inflammatory aetiologies. Circulating intravenous immunoglobulins combined with a low blood pressure was considered the most probable cause of his stroke. Conclusions Cerebral infarction following intravenous immunoglobulin is thought to be secondary to hyperviscosity, thromboemboli, vasculitis, or cerebral vasospasm and reported to occur after a short latency when the immunoglobulin load is highest. Even though the immunoglobulin load is halved by 3 weeks, our case suggests that that the predisposition to thromboembolism persists over a longer period and may result in vascular complications if synergised with other vascular risk factors. It is recommended that intravenous immunoglobulin be infused at a rate of not less than 8 hours per day and that factors predisposing to thromboembolism such as dehydration, immobilisation and low blood pressure be avoided for the duration of at least two half-lives of immunoglobulin (6 weeks). PMID:24661403

  6. Acute confusional migraine in an adolescent: response to intravenous valproate.

    PubMed

    Avraham, Shelly Ben; Har-Gil, Miki; Watemberg, Nathan

    2010-04-01

    Acute confusional migraine (ACM) is a dramatic, rare manifestation of migraine described mostly for children and adolescents. There are few data on the treatment of an ACM attack. Prochlorperazine has been suggested as an effective drug. The authors of some reports have suggested that valproic acid may play a role in the prevention of ACM and as treatment for acute migraine headache in the adult population. However, this medication has not been reported as first-line, acute therapy for ACM. We report here the case of a 12-year-old girl who presented with an ACM attack that resolved rapidly after intravenous administration of valproic acid. PMID:20211950

  7. Tetrakis(p-Carboranylthio-Tetrafluorophenyl)Chlorin (TPFC): Application for Photodynamic Therapy and Boron Neutron Capture Therapy.

    PubMed

    Hiramatsu, Ryo; Kawabata, Shinji; Tanaka, Hiroki; Sakurai, Yoshinori; Suzuki, Minoru; Ono, Koji; Miyatake, Shin-Ichi; Kuroiwa, Toshihiko; Hao, Erhong; Vicente, M Graça H

    2015-03-01

    Carboranyl-containing chlorins have emerged as promising dual sensitizers for use in both photodynamic therapy (PDT) and boron neutron capture therapy (BNCT), by virtue of their known tumor affinity, low cytotoxicity in dark conditions, and their strong absorptions in the red region of the optical spectrum. Tetrakis(p-carboranylthio-tetrafluorophenyl)chlorin (TPFC) is a new synthetic carboranyl-containing chlorin of high boron content (24% by weight). To evaluate TPFC's applicability as sensitizer for both PDT and BNCT, we performed an in vitro and in vivo study using F98 rat glioma cells and F98 rat glioma-bearing brain tumor models. For the in vivo BNCT study, we used boronophenylalanine (BPA), which is currently used in clinical BNCT studies, via intravenous administration (i.v.) and/or used TPFC via convection-enhanced delivery (CED), a method for local drug infusion directly into the brain. In the in vitro PDT study, the cell surviving fraction following laser irradiation (9 J/cm(2) ) was 0.035 whereas in the in vitro BNCT study, the cell surviving fraction following neutron irradiation (thermal neutron = 1.73 × 10(12) n/cm(2) ) was 0.04. In the in vivo BNCT study, the median survival time following concomitant administration of BPA (i.v.) and TPFC (CED) was 42 days (95% confidence interval; 37-43 days). © 2014 Wiley Periodicals, Inc. and the American Pharmacists Association J Pharm Sci 104:962-970, 2015. PMID:25546823

  8. IVS Organization

    NASA Technical Reports Server (NTRS)

    2004-01-01

    International VLBI Service (IVS) is an international collaboration of organizations which operate or support Very Long Baseline Interferometry (VLBI) components. The goals are: To provide a service to support geodetic, geophysical and astrometric research and operational activities. To promote research and development activities in all aspects of the geodetic and astrometric VLBI technique. To interact with the community of users of VLBI products and to integrate VLBI into a global Earth observing system.

  9. First-phase insulin release during the intravenous glucose tolerance test as a risk factor for type 1 diabetes

    Microsoft Academic Search

    H. Peter Chase; David D. Cuthbertson; Lawrence M. Dolan; Francine Kaufman; Jeffrey P. Krischer; Desmond A. Schatz; Neil H. White; Darrell M. Wilson; Joseph Wolfsdorf

    2001-01-01

    Objective: To determine the relationship between first-phase (1 minute + 3 minutes) insulin production during the intravenous glucose tolerance test (IV-GTT) and risk factors for developing type 1 diabetes. Study Design: Relatives of persons with type 1 diabetes (n = 59,600) were screened for islet cell antibodies (ICAs). Subjects who had positive screening results underwent IV-GTT (?2 times), repeat ICA

  10. Intravenous Thrombolysis for Acute Cerebral Ischaemia: Comparison of Outcomes between Patients Treated at Working versus Nonworking Hours

    Microsoft Academic Search

    Marie Bodenant; Didier Leys; Stéphanie Debette; Charlotte Cordonnier; Frédéric Dumont; Hilde Hénon; Marie Girot; Christian Lucas; David Devos; Luc Defebvre; Dominique Deplanque; Xavier Leclerc; Régis Bordet

    2010-01-01

    Background: Stroke outcomes are worse in patients admitted at nonworking hours (NWH), but whether this is also true in patients treated with intravenous (i.v.) thrombolysis has not been definitely proven. Objective: Our aim was to test the hypothesis that stroke patients treated by i.v. rt-PA at NWH have a worse outcome than those treated at working hours (WH). Methods: We

  11. Do two intravenous iron sucrose preparations have the same efficacy?

    PubMed Central

    Kadri, Ahmed; Leonard, Emmanuelle; Dansaert, Aurélie; Lafuma, Antoine

    2011-01-01

    Background. Intravenous (i.v.) iron sucrose similar (ISS) preparations are available but clinical comparisons with the originator iron sucrose (IS) are lacking. Methods. The impact of switching from IS to ISS on anaemia and iron parameters was assessed in a sequential observational study comparing two periods of 27 weeks each in 75 stable haemodialysis (HD) patients receiving i.v. iron weekly and an i.v. erythropoiesis-stimulating agent (ESA) once every 2 weeks. Patients received IS in the first period (P1) and ISS in the second period (P2). Results. Mean haemoglobin value was 11.78 ± 0.99 g/dL during P1 and 11.48 ± 0.98 g/dL during P2 (P = 0.01). Mean serum ferritin was similar for both treatment periods (P1, 534 ± 328 ?g/L; P2, 495 ± 280 ?g/L, P = 0.25) but mean TSAT during P1 (49.3 ± 10.9%) was significantly higher than during P2 (24.5 ± 9.4%, P <0.0001). The mean dose of i.v. iron per patient per week was 45.58 ± 32.55 mg in P1 and 61.36 ± 30.98 mg in P2 (+34.6%), while the mean ESA dose was 0.58 ± 0.52 and 0.66 ± 0.64 ?g/kg/week, respectively (+13.8%). Total mean anaemia drug costs increased in P2 by 11.9% compared to P1. Conclusions. The switch from the originator IS to an ISS preparation led to destabilization of a well-controlled population of HD patients and incurred an increase in total anaemia drug costs. Prospective comparative clinical studies are required to prove that ISS are as efficacious and safe as the originator i.v. IS. PMID:21355067

  12. A prototype space flight intravenous injection system

    NASA Technical Reports Server (NTRS)

    Colombo, G. V.

    1985-01-01

    Medical emergencies, especially those resulting from accidents, frequently require the administration of intravenous fluids to replace lost body liquids. The development of a prototype space flight intravenous injection system is presented. The definition of requirements, injectable concentrates development, water polisher, reconstitution hardware development, administration hardware development, and prototype fabrication and testing are discussed.

  13. Intravenous sedation for third molar surgery.

    PubMed

    Grainger, J K

    1993-01-01

    The surgical removal of third molars is a frequently carried out procedure under day-stay general anesthesia. Economic considerations and the demand on hospital facilities together with the reduced incidence of morbidity suggest that intravenous sedation is an excellent alternative modality. Thirty cases of third molar surgery with intravenous sedation are described wherein excellent operating conditions and reduced morbidity are reported. PMID:8219933

  14. Pharmacokinetics and Pharmacodynamics of Once-Daily Administration of Intravenous Tobramycin in Adult Patients with Cystic Fibrosis Hospitalized for an Acute Pulmonary Exacerbation

    PubMed Central

    Butterfield, Jill M.; Lodise, Thomas P.; Beegle, Scott; Rosen, Jonathan; Farkas, Joshua

    2013-01-01

    The serum pharmacokinetic profile of intravenous (i.v.) tobramycin administration was characterized for a sample of nine adult patients with cystic fibrosis (CF) who were hospitalized for an acute pulmonary exacerbation. Current recommended i.v. tobramycin dosing protocols are predicted through modeling and simulation to be suboptimal. Empirical tobramycin regimens of ?15 mg/kg of body weight administered i.v. once daily should be evaluated for adult patients with CF to optimize outcomes. PMID:23896470

  15. Pharmacokinetics and pharmacodynamics of once-daily administration of intravenous tobramycin in adult patients with cystic fibrosis hospitalized for an acute pulmonary exacerbation.

    PubMed

    Butterfield, Jill M; Lodise, Thomas P; Beegle, Scott; Rosen, Jonathan; Farkas, Joshua; Pai, Manjunath P

    2013-10-01

    The serum pharmacokinetic profile of intravenous (i.v.) tobramycin administration was characterized for a sample of nine adult patients with cystic fibrosis (CF) who were hospitalized for an acute pulmonary exacerbation. Current recommended i.v. tobramycin dosing protocols are predicted through modeling and simulation to be suboptimal. Empirical tobramycin regimens of ?15 mg/kg of body weight administered i.v. once daily should be evaluated for adult patients with CF to optimize outcomes. PMID:23896470

  16. Monitoring Intravenous Recombinant Tissue Plasminogen Activator Thrombolysis for Acute Ischemic Stroke With Diffusion and Perfusion MRI

    Microsoft Academic Search

    Peter D. Schellinger; Olav Jansen; Jochen B. Fiebach; Sabine Heiland; Thorsten Steiner; Stefan Schwab; Olivia Pohlers; Henning Ryssel; Klaus Sartor; Werner Hacke

    Background and Purpose—Intravenous recombinant tissue plasminogen activator (rtPA) administration is an effective therapy for ischemic stroke when initiated within 3 hours and possibly up to 6 hours after symptom onset. To improve patient selection, a fast diagnostic tool that allows reliable diagnosis of hemorrhage and ischemia, vessel status, and tissue at risk at an early stage may be useful. We

  17. Liver transplantation in patients with severe portopulmonary hypertension treated with preoperative chronic intravenous epoprostenol

    Microsoft Academic Search

    Henkie P. Tan; Jay S. Markowitz; Robert A. Montgomery; William T. Merritt; Andrew S. Klein; Paul J. Thuluvath; F. Fred Poordad; Warren R. Maley; Bradford Winters; Seda B. Akinci; Sean P. Gaine

    2001-01-01

    Portopulmonary hypertension (PPHTN) is no longer an absolute contraindication to orthotopic liver transplantation (OLT). The pre-OLT management of patients with PPHTN requires early diagnosis and chronic therapy with intravenous epoprostenol to decrease pulmonary vascular resistance (PVR). Close follow-up is necessary to reassess pulmonary artery pressures (PAPs) and evaluate right ventricular (RV) function. This assists in the optimal timing of OLT.

  18. Intravenous immunoglobulin treatment of multiple sclerosis and its animal model, experimental autoimmune encephalomyelitis

    Microsoft Academic Search

    Signe Humle Jorgensen; Per Soelberg Sorensen

    2005-01-01

    Intravenous immunoglobulin (IVIG) is an established treatment of immune-mediated demyelinating neuropathy. Since IVIG possesses multiple immunomodulatory and anti-inflammatory properties, IVIG therapy may represent a way of interfering with the disease process in multiple sclerosis (MS). In the MS animal model experimental autoimmune encephalomyelitis (EAE), infusions of IVIG significantly reduced disease symptoms as well as the underlying CNS pathology. IVIG was

  19. Intravenous Lidocaine Versus Intravenous Amiodarone (in a New

    E-print Network

    failed to terminate VT, the patient was crossed over to the alternative therapy. Twenty-nine patients delete- rious cardiovascular effects. Tween 80 and benzyl alcohol are both known to exhibit negative inotropy and hypotension.12­16 The reason for using Tween 80 and benzyl alcohol is to solubilize

  20. Portable Intravenous Fluid Production Device for Ground Use

    NASA Technical Reports Server (NTRS)

    Scarpa, Philip J.; Scheuer, Wolfgang K.

    2012-01-01

    There are several medical conditions that require intravenous (IV) fluids. Limitations of mass, volume, storage space, shelf-life, transportation, and local resources can restrict the availability of such important fluids. These limitations are expected in long-duration space exploration missions and in remote or austere environments on Earth. Current IV fluid production requires large factory-based processes. Easy, portable, on-site production of IV fluids can eliminate these limitations. Based on experience gained in developing a device for spaceflight, a ground-use device was developed. This design uses regular drinking water that is pumped through two filters to produce, in minutes, sterile, ultrapure water that meets the stringent quality standards of the United States Pharmacopeia for Water for Injection (Total Bacteria, Conductivity, Endotoxins, Total Organic Carbon). The device weighs 2.2 lb (1 kg) and is 10 in. long, 5 in. wide, and 3 in. high (.25, 13, and 7.5 cm, respectively) in its storage configuration. This handheld device produces one liter of medical-grade water in 21 minutes. Total production capacity for this innovation is expected to be in the hundreds of liters.

  1. Radiation Therapy With Cisplatin, Docetaxel, or Cetuximab After Surgery in Treating Patients With Stage III-IV Squamous Cell Head and Neck Cancer

    ClinicalTrials.gov

    2014-10-27

    Stage III Squamous Cell Carcinoma of the Hypopharynx; Stage III Squamous Cell Carcinoma of the Larynx; Stage III Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage III Squamous Cell Carcinoma of the Oropharynx; Stage III Verrucous Carcinoma of the Larynx; Stage III Verrucous Carcinoma of the Oral Cavity; Stage IV Squamous Cell Carcinoma of the Hypopharynx; Stage IVA Squamous Cell Carcinoma of the Larynx; Stage IVA Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage IVA Squamous Cell Carcinoma of the Oropharynx; Stage IVA Verrucous Carcinoma of the Larynx; Stage IVA Verrucous Carcinoma of the Oral Cavity; Stage IVB Squamous Cell Carcinoma of the Larynx; Stage IVB Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage IVB Squamous Cell Carcinoma of the Oropharynx; Stage IVB Verrucous Carcinoma of the Larynx; Stage IVB Verrucous Carcinoma of the Oral Cavity; Tongue Cancer

  2. The comparison of extemporaneous preparations of omeprazole, pantoprazole oral suspension and intravenous pantoprazole on the gastric pH of critically ill-patients

    PubMed Central

    Dabiri, Yasamin; Fahimi, Fanak; Jamaati, Hamidreza; Hashemian, Seyed Mohammad Reza

    2015-01-01

    Background: Stress-related mucosal disease occurs in many critically ill-patients within 24 h of admission. Proton pump inhibitor therapy has been documented to produce more potent inhibition of gastric acid secretion than histamine 2 receptor antagonists. This study aimed to compare extemporaneous preparations of omeprazole, pantoprazole oral suspension and intravenous (IV) pantoprazole on the gastric pH in intensive care unit patients. Materials and Methods: This was a randomized single-blind-study. Patients of ? 16 years of age with a nasogastric tube, who required mechanical ventilation for ? 48 h, were eligible for inclusion. The excluded patients were those with active gastrointestinal bleeding, known allergy to omeprazole and pantoprazole and those intolerant to the nasogastric tube. Fifty-six patients were randomized to treatment with omeprazole suspension 2 mg/ml (40 mg every day), pantoprazole suspension 2 mg/ml (40 mg every day) and IV pantoprazole (40 mg every day) for up to 14 days. Gastric aspirates were sampled before and 1-2.5 h after the drug administration for the pH measurement using an external pH meter. Data were analyzed using SPSS (version 21.0). Results: In this study, 56 critically ill-patients (39 male, 17 female, mean age: 61.5 ± 15.65 years) were followed for the control of the gastric pH. On each of the 14 trial days the mean of the gastric pH alteration was significantly higher in omeprazole and pantoprazole suspension-treated patients than in IV pantoprazole-treated patients (P < 0.001). Conclusion: Omeprazole and pantoprazole oral suspension are more effective than IV pantoprazole in increasing the gastric pH. PMID:25624646

  3. IV Medication Safety Software Implementation in a Multihospital Health System

    Microsoft Academic Search

    Angela T. Cassano

    2006-01-01

    A number of technological advances are becoming incorpo- rated into institutional pharmacy practice in order to reduce the frequen- cy and severity of medication errors. One of these has great promise. They deal with intravenous (IV) medication safety systems, wherein cus- tomized drug software is interfaced with \\

  4. Intracerebral Hemorrhage after Intravenous Thrombolysis in Patients with Cerebral Microbleeds and Cardiac Myxoma

    PubMed Central

    Chutinet, Aurauma; Roongpiboonsopit, Duangnapa; Suwanwela, Nijasri C.

    2014-01-01

    Background and purpose: Cardiac myxoma is a rare etiology of stroke. Both cerebral microbleeds and cardiac myxoma may increase the risk of intracerebral hemorrhage after intravenous (IV) thrombolysis. However, data are still limited. We report a case of multiple cerebral microbleeds treated with IV thrombolysis with later findings of cardiac myxoma. Summary of case: A 58-year-old-man presented with right-sided hemiplegia and global aphasia. The presumptive diagnosis of acute left middle cerebral artery (MCA) infarction was made. Previous magnetic resonance imaging showed multiple cerebral microbleeds. The patient received IV thrombolysis. Bilateral cerebellar hemorrhage occurred after thrombolysis, and a median suboccipital craniectomy and hematoma removal was performed. Transthoracic echocardiogram found a left atrial myxoma. The tumor was then surgically removed. Six months later, neurological deficit improved. Conclusion: Cerebral microbleeds may be associated with atrial myxoma. IV thrombolysis could benefit acute ischemic stroke patients with both baseline cerebral microbleeds and atrial myxoma. PMID:25520700

  5. Possible Hepatotoxicity Associated With Intravenous Acetaminophen in a 36-Year-Old Female Patient

    PubMed Central

    Lee, Philip J.; Shen, Mark; Wang, Shan; Spiegler, Peter; Caraccio, Thomas; DeMuro, Jonas P.; Malone, Brian

    2015-01-01

    We present a case of a 36-year-old female who came into the emergency department with right-side abdominal pain. She went to the operating room for a diagnostic laparoscopy and appendectomy. She received intravenous (IV) acetaminophen every six hours both preoperatively and postoperatively for pain control. The patient’s aspartate aminotransferase and alanine aminotransferase levels were elevated and peaked at 4,833 and 6,600 IU/L, respectively, from baselines of 14 and 15, respectively, while she was receiving 16 doses of IV acetaminophen. The patient was transferred to a regional liver transplant center for evaluation for a transplant. She was treated with IV N-acetylcysteine and discharged with a normal liver-function test without a transplant. This case report supports the possibility of hepatotoxicity associated with IV acetaminophen. PMID:25673962

  6. Comparison of intravenous versus topical tranexamic acid in total knee arthroplasty: a prospective randomized study.

    PubMed

    Patel, Jay N; Spanyer, Jonathon M; Smith, Langan S; Huang, Jiapeng; Yakkanti, Madhusudhan R; Malkani, Arthur L

    2014-08-01

    The purpose of this study was to compare the efficacy of topical Tranexamic Acid (TXA) versus Intravenous (IV) Tranexamic Acid for reduction of blood loss following primary total knee arthroplasty (TKA). This prospective randomized study involved 89 patients comparing topical administration of 2.0g TXA, versus IV administration of 10mg/kg. There were no differences between the two groups with regard to patient demographics or perioperative function. The primary outcome measure, perioperative change in hemoglobin level, showed a decrease of 3.06 ± 1.02 in the IV group and 3.42 ± 1.07 in the topical group (P = 0.108). There were no statistical differences between the groups in preoperative hemoglobin level, lowest postoperative hemoglobin level, or total drain output. One patient in the topical group required blood transfusion (P = 0.342). Based on our study, topical Tranexamic Acid has similar efficacy to IV Tranexamic Acid for TKA patients. PMID:24768543

  7. Possible hepatotoxicity associated with intravenous acetaminophen in a 36-year-old female patient.

    PubMed

    Lee, Philip J; Shen, Mark; Wang, Shan; Spiegler, Peter; Caraccio, Thomas; DeMuro, Jonas P; Malone, Brian

    2015-02-01

    We present a case of a 36-year-old female who came into the emergency department with right-side abdominal pain. She went to the operating room for a diagnostic laparoscopy and appendectomy. She received intravenous (IV) acetaminophen every six hours both preoperatively and postoperatively for pain control. The patient's aspartate aminotransferase and alanine aminotransferase levels were elevated and peaked at 4,833 and 6,600 IU/L, respectively, from baselines of 14 and 15, respectively, while she was receiving 16 doses of IV acetaminophen. The patient was transferred to a regional liver transplant center for evaluation for a transplant. She was treated with IV N-acetylcysteine and discharged with a normal liver-function test without a transplant. This case report supports the possibility of hepatotoxicity associated with IV acetaminophen. PMID:25673962

  8. The significance of the blood glucose level for plasma insulin response to intravenously administered tolbutamide in healthy subjects

    Microsoft Academic Search

    E. Cerasi; I. Chowers; R. Luft; A. Widström

    1969-01-01

    Summary  The effect of intravenous tolbutamide on insulin release in normal human subjects was investigated under various experimental conditions. The blood glucose level was either allowed to fall after i.v. tolbutamide or kept within normal limits by a concomitant glucose infusion. In other experiments, tolbutamide was given during different degrees of hypoglycaemia induced by insulin. It was found that tolbutamide provoked

  9. Intravenous Ethanol Infusions Can Mimic the Time Course of Breath Alcohol Concentrations Following Oral Alcohol Administration in Healthy Volunteers

    Microsoft Academic Search

    Vijay A. Ramchandani; Martin Plawecki; Ting-Kai Li; Sean O’Connor

    2009-01-01

    Background: Our previous studies have used intravenous (IV) clamping methods to demon- strate that family history positive (FHP) subjects exhibit a greater initial response to alcohol than family history negative (FHN) subjects. These results differ from other studies of family history of alcoholism (FHA) influences, most of which have used an oral alcohol challenge, suggesting that the route of administration

  10. ENHANCED RATE OF ETHANOL ELIMINATION FROM BLOOD AFTER INTRAVENOUS ADMINISTRATION OF AMINO ACIDS COMPARED WITH EQUICALORIC GLUCOSE

    Microsoft Academic Search

    BJORN LISANDER; OLLE LUNDVALL; JENS TOMNER; ALAN W. JONES

    2006-01-01

    Aims: To investigate the effect of an amino acid mixture given intravenously (i.v.) on the rate of ethanol elimination from blood compared with equicaloric glucose and Ringer's acetate as control treatments. Methods: In a randomized cross-over study, six healthy men (mean age 23 years) fasted overnight before receiving either Ringer's acetate, glucose or the amino acid mixture (Vamin 18 g

  11. Nursing advocacy and the accuracy of intravenous to oral opioid conversion at discharge in the cancer patient

    Microsoft Academic Search

    Maria L Gallo

    2009-01-01

    Pain is a common problem for cancer patients at home and when hospitalized. Pain interferes with all aspects of a patient's life including sleep, appetite, sexual desire, emotion and productivity. The under-prescribing of opioids can lead to uncontrolled pain in cancer patients. This study examined nursing advocacy related to pain management and the accuracy of the intravenous (IV) to oral

  12. The analgesic effect of lornoxicam when added to lidocaine for intravenous regional anaesthesia

    Microsoft Academic Search

    S. Sen; B. Ugur; O. N. Aydin; M. Ogurlu; E. Gezer; O. Savk

    2006-01-01

    Background. The aim of the study was to evaluate the effect of lornoxicam (L) on sensory and motor block onset time, tourniquet pain, and postoperative analgesia, when added to lidocaine in intravenous regional anaesthesia (IVRA). Methods. Forty-five patients undergoing hand surgery were randomly and blindly divided into three groups as to receive either i.v. saline and IVRA with lidocaine 0.5%

  13. The effect of intravenous ketorolac given intraoperatively versus postoperatively on outcome from gynecologic abdominal surgery

    Microsoft Academic Search

    Philip Balestrieri; Gary Simmons; Douglas Hill; Jean Brown; Alice Jackson; Sorin J. Brull; Thomas J. Maneatis; Arna Shefrin; Lincoln Bynum; Dorene A. O'Hara

    1997-01-01

    Study Objectives: To examine the effect of timing of an intravenous (IV) dose (intraoperative vs. postoperative) of ketorolac tromethamine on pain scores and overall outcome after total abdominal hysterectomy (TAH) and myomectomy.Design: Prospective, randomized, placebo-controlled study.Patients: 248 ASA physical status I and II adult female patients scheduled for elective hysterectomy or myomectomy.Interventions: General anesthesia was administered that consisted of thiopental

  14. [Iron substitution in outpatients in Switzerland: Increase of costs associated with intravenous administration].

    PubMed

    Giger, Max; Achermann, Rita

    2013-01-01

    Iron anaemia and iron-deficient erythropoiesis are treated with oral iron supplements. For chronic haemodialysis or in the case of therapy failure or intolerance to oral iron therapy, intravenous supplements are administered. The costs of iron supplements borne by statutory health care insurance had strongly increased during the observation period from 2006 to 2010. Based on the invoice data of a large health insurance company with a market share of around 18 %, prescription data of iron preparations and laboratory tests were analysed and extrapolated to the Swiss population. During the 5-year observation period, costs of intravenous iron substitution increased by 16.5 m EUR (340.3 %) and the number of individuals treated by 243.5 %. A sharp rise was observed in women of menstruating age, which was mainly due to prescriptions issued by primary care physicians. More than 8 % of intravenous iron substitutions were administered without prior laboratory analysis,and must therefore be regarded as off-label use. A cost-benefit analysis is needed to demonstrate the additional value of intravenous over oral iron supplementation, and intravenous iron supplementation should be administered only to patients with proven iron deficiency. PMID:23916272

  15. Intravenous zoledronic acid for the treatment of osteoporosis: The evidence of its therapeutic effect

    PubMed Central

    Lewiecki, E Michael

    2010-01-01

    Introduction: Osteoporosis is a disease characterized by low bone mineral density and poor bone quality resulting in reduced bone strength and increased risk of fracture. Oral bisphosphonates, first-line therapy for most patients with osteoporosis, are associated with suboptimal adherence to therapy due to factors that include a complex dosing regimen and gastrointestinal intolerance in some patients. Intravenous bisphosphonates address these limitations through infrequent injectable dosing that assures 100% bioavailability. Intravenous zoledronic acid is the newest bisphosphonate to be approved for the treatment of osteoporosis. Aims: This review assesses the evidence for the therapeutic effects of intravenous zoledronic acid for the treatment of osteoporosis. Evidence review: Zoledronic acid 5 mg administered as an annual 15-min intravenous infusion has been shown to reduce the risk of vertebral fractures, hip fractures, and other fractures in a three-year randomized, double-blind, placebo-controlled trial in women with postmenopausal osteoporosis. In a randomized, double-blind, placebo-controlled trial in women and men with a recent surgical repair of low-trauma hip fracture, it reduced the risk of new clinical fractures and improved survival. In both studies, zoledronic acid was associated with a good safety profile and was generally well tolerated. Zoledronic acid has the potential to improve clinical outcomes by reducing the risk of fracture in patients with osteoporosis. Clinical value: Intravenous zoledronic acid 5 mg every 12 months reduces fracture risk in women with postmenopausal osteoporosis and in women and men with recent low-trauma hip fracture. PMID:20694061

  16. Cangrelor: a novel intravenous antiplatelet agent with a questionable future.

    PubMed

    Waite, Laura H; Phan, Yvonne L; Spinler, Sarah A

    2014-10-01

    Current percutaneous coronary intervention (PCI) guidelines recommend the use of a P2Y12 inhibitor with aspirin and an injectable anticoagulant. However, available oral P2Y12 inhibitor therapy is limited by significant drug interactions, unclear oral absorption in selected clinical conditions, and delayed onset and offset of activity that may be cumbersome for patients requiring coronary artery bypass graft (CABG) surgery. Cangrelor, a novel intravenous P2Y12 inhibitor, offers potential advantages compared with currently available oral agents, particularly in regard to rapid onset and offset of platelet inhibition. The Cangrelor versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition (CHAMPION) trials compared cangrelor versus an oral loading dose of clopidogrel, given before or after PCI, in patients with both stable and acute coronary syndromes. The results were conflicting, but some evidence demonstrated a lower rate of stent thrombosis compared with clopidogrel and lower rates of a composite cardiovascular end point, with comparable bleeding rates. The BRIDGE study assessed cangrelor as a replacement for oral P2Y12 inhibitors in patients awaiting CABG surgery and demonstrated that cangrelor maintained platelet inhibition during the preoperative period and enabled a rapid return to baseline platelet function upon cessation of the infusion. A new drug application was submitted to the Food and Drug Administration (FDA) for use during PCI to prevent thrombotic events and as bridging therapy for patients awaiting surgery who require therapy with P2Y12 inhibitors. In February 2014, the FDA's Cardiovascular and Renal Drugs Advisory Committee recommended against approval due to concerns over an appropriate risk-benefit ratio for use during PCI and a lack of evidence supporting the bridging indication. On April 30, 2014, the FDA issued a Complete Response letter for the PCI and bridging indications, denying approval and requesting further data. The future of this once promising novel intravenous antiplatelet agent is now in question. PMID:25123696

  17. Intravenous regional anesthesia with meperidine.

    PubMed

    Acalovschi, I; Cristea, T

    1995-09-01

    Forty-five ASA physical status I volunteers, divided in three groups of 15 each, received intravenous regional anesthesia (IVRA) of the upper limb with 40 mL meperidine 0.25%, lidocaine 0.5%, or 0.9% sodium chloride (isolated ischemia) by random allocation. Using a double-blind method, the onset and recovery of sensory block was tested at six sites of the forearm and hand. The onset of complete motor block was also assessed. The symptoms after deflation of the tourniquet were recorded. The onset of block, as determined by pin-prick touch, and cold was significantly faster in the meperidine group (P < 0.001) than in the saline group, but also slower (P < 0.001) than in the lidocaine group. After the tourniquet was deflated, recovery occurred in reverse order. A complete motor block was noted in all volunteers from the meperidine and lidocaine groups, but in only 11 cases from the 0.9% sodium chloride group (P < 0.01). In the meperidine group, motor block developed concomitantly or prior to sensory block. There was a significant increase in the incidence of dizziness, nausea, and pain at the injection site in the meperidine group in comparison with the lidocaine group. We conclude that meperidine has local anesthetic action on the peripheral nerve in vivo, but that its single use for IVRA should be a second choice for patients allergic to local anesthetics. PMID:7653819

  18. Improved tumor imaging and therapy via i.v. IgG–mediated time-sequential modulation of neonatal Fc receptor

    PubMed Central

    Singh Jaggi, Jaspreet; Carrasquillo, Jorge A.; Seshan, Surya V.; Zanzonico, Pat; Henke, Erik; Nagel, Andrew; Schwartz, Jazmin; Beattie, Brad; Kappel, Barry J.; Chattopadhyay, Debjit; Xiao, Jing; Sgouros, George; Larson, Steven M.; Scheinberg, David A.

    2007-01-01

    The long plasma half-life of IgG, while allowing for enhanced tumor uptake of tumor-targeted IgG conjugates, also results in increased background activity and normal-tissue toxicity. Therefore, successful therapeutic uses of conjugated antibodies have been limited to the highly sensitive and readily accessible hematopoietic tumors. We report a therapeutic strategy to beneficially alter the pharmacokinetics of IgG antibodies via pharmacological inhibition of the neonatal Fc receptor (FcRn) using high-dose IgG therapy. IgG-treated mice displayed enhanced blood and whole-body clearance of radioactivity, resulting in better tumor-to-blood image contrast and protection of normal tissue from radiation. Tumor uptake and the resultant therapeutic response was unaltered. Furthermore, we demonstrated the use of this approach for imaging of tumors in humans and discuss its potential applications in cancer imaging and therapy. The ability to reduce the serum persistence of conjugated IgG antibodies after their infusion can enhance their therapeutic index, resulting in improved therapeutic and diagnostic efficacy. PMID:17717602

  19. The safety and tolerability of different intravenous administrations of levetiracetam, bolus versus infusion, in intensive care unit patients.

    PubMed

    Burakgazi, Evren; Bashir, Sairah; Doss, Vindoth; Pellock, Jack

    2014-04-01

    This study reviews our experience with the safety and tolerability of levetiracetam (LVM) with different methods of intravenous administration in intensive care unit (ICU) patients. We used retrospective chart review to identify 33 ICU patients who received intravenous LVM for treatment of seizures. Collected data included age, gender, diagnosis on admission, dosing regimen, documented seizure activity, adverse reactions, concomitant use of other antiepileptic drugs, and condition on discharge. A total of 33 ICU patients were given intravenous (IV) LVM as add-on treatment to standard regimen for treatment of breakthrough seizures or status epilepticus or given as preventive medication postoperatively. Among these 33 patients, 16 received intravenous LVM as bolus, and 17 received intravenous LVM as continuous infusion. Safety and tolerability of intravenous LVM were evaluated on the basis of the occurrence of adverse or side effects reported in daily progress notes of the physicians and nurses. There were no significant adverse or side effects reported in daily progress notes. The addition of intravenous LVM to the standard regimen for controlling seizures in ICU patients seems feasible and tolerable. PMID:24357676

  20. Final Report for Intravenous Fluid Generation (IVGEN) Spaceflight Experiment

    NASA Technical Reports Server (NTRS)

    McQuillen, John B.; McKay, Terri L.; Griffin, DeVon W.; Brown, Dan F.; Zoldak, John T.

    2011-01-01

    NASA designed and operated the Intravenous Fluid Generation (IVGEN) experiment onboard the International Space Station (ISS), Increment 23/24, during May 2010. This hardware was a demonstration experiment to generate intravenous (IV) fluid from ISS Water Processing Assembly (WPA) potable water using a water purification technique and pharmaceutical mixing system. The IVGEN experiment utilizes a deionizing resin bed to remove contaminants from feedstock water to a purity level that meets the standards of the United States Pharmacopeia (USP), the governing body for pharmaceuticals in the United States. The water was then introduced into an IV bag where the fluid was mixed with USP-grade crystalline salt to produce USP normal saline (NS). Inline conductivity sensors quantified the feedstock water quality, output water purity, and NS mixing uniformity. Six 1.5-L bags of purified water were produced. Two of these bags were mixed with sodium chloride to make 0.9 percent NS solution. These two bags were returned to Earth to test for compliance with USP requirements. On-orbit results indicated that all of the experimental success criteria were met with the exception of the salt concentration. Problems with a large air bubble in the first bag of purified water resulted in a slightly concentrated saline solution of 117 percent of the target value of 0.9 g/L. The second bag had an inadequate amount of salt premeasured into the mixing bag resulting in a slightly deficient salt concentration of 93.8 percent of the target value. The USP permits a range from 95 to 105 percent of the target value. The testing plans for improvements for an operational system are also presented.

  1. Intravenous sodium nitrite in acute ST-elevation myocardial infarction: a randomized controlled trial (NIAMI)

    PubMed Central

    Siddiqi, Nishat; Neil, Christopher; Bruce, Margaret; MacLennan, Graeme; Cotton, Seonaidh; Papadopoulou, Sofia; Feelisch, Martin; Bunce, Nicholas; Lim, Pitt O.; Hildick-Smith, David; Horowitz, John; Madhani, Melanie; Boon, Nicholas; Dawson, Dana; Kaski, Juan Carlos; Frenneaux, Michael; Siddiqi, Nishat; Neil, Christopher; Bruce, Margaret; MacLennan, Graeme; Cotton, Seonaidh; Dawson, Dana; Frenneaux, Michael; Singh, Satnam; Schwarz, Konstantin; Jagpal, Baljit; Metcalfe, Malcolm; Stewart, Andrew; Hannah, Andrew; Awsan, Noman; Broadhurst, Paul; Hogg, Duncan; Garg, Deepak; Slattery, Elaine; Davidson, Tracey; McDonald, Alison; McPherson, Gladys; Kaski, Juan-Carlos; Lim, Pitt O; Brown, Sue; Papadopoulou, Sofia A; Gonzalvez, Fatima; Roy, David; Firoozi, Sami; Bogle, Richard; Roberts, Elved; Rhodes, Jonathan; Hildick-Smith, David; de Belder, Adam; Cooter, Nina; Bennett, Lorraine; Horowitz, John; Rajendran, Sharmalar; Dautov, Rustem; Black, Marilyn; Jansen, Else; Boon, Nicholas; Struthers, Allan; Toff, William; Dargie, Henry; Lang, Chim; Nightingale, Peter

    2014-01-01

    Aim Despite prompt revascularization of acute myocardial infarction (AMI), substantial myocardial injury may occur, in part a consequence of ischaemia reperfusion injury (IRI). There has been considerable interest in therapies that may reduce IRI. In experimental models of AMI, sodium nitrite substantially reduces IRI. In this doubleblind randomized placebo controlled parallel-group trial, we investigated the effects of sodium nitrite administered immediately prior to reperfusion in patients with acute ST-elevation myocardial infarction (STEMI). Methods and results A total of 229 patients presenting with acute STEMI were randomized to receive either an i.v. infusion of 70 ?mol sodium nitrite (n = 118) or matching placebo (n = 111) over 5 min immediately before primary percutaneous intervention (PPCI). Patients underwent cardiac magnetic resonance imaging (CMR) at 6–8 days and at 6 months and serial blood sampling was performed over 72 h for the measurement of plasma creatine kinase (CK) and Troponin I. Myocardial infarct size (extent of late gadolinium enhancement at 6–8 days by CMR-the primary endpoint) did not differ between nitrite and placebo groups after adjustment for area at risk, diabetes status, and centre (effect size ?0.7% 95% CI: ?2.2%, +0.7%; P = 0.34). There were no significant differences in any of the secondary endpoints, including plasma troponin I and CK area under the curve, left ventricular volumes (LV), and ejection fraction (EF) measured at 6–8 days and at 6 months and final infarct size (FIS) measured at 6 months. Conclusions Sodium nitrite administered intravenously immediately prior to reperfusion in patients with acute STEMI does not reduce infarct size. PMID:24639423

  2. Pharmacokinetics and tissue distribution of a novel marine fibrinolytic compound in Wistar rat following intravenous administrations.

    PubMed

    Su, Tongwei; Wu, Wenhui; Yan, Ting; Zhang, Chaoyan; Zhu, Quangang; Bao, Bin

    2013-12-30

    We investigated a novel marine fibrinolytic compound for use in thrombolytic therapy. Pharmacokinetics and the tissue distribution of this novel marine fibrinolytic compound, FGFC1(2) (fungi fibrinolytic compound 1), were investigated in Wistar rats after intravenous (IV) bolus administration of two concentrations (10 and 20mg/kg). Plasma FGFC1 and tissue extracts were measured using HPLC with UV detection. FGFC1 was detected using a C18 column with a gradient eluted mobile phase of acetonitrile-water (0.1% trifluoroacetic acid), 1.0mL/min. Chromatograms were monitored at 265nm (column temperature: 40°C). Pharmacokinetic data indicate that FGFC1 fitted well to a two-compartment model. Elimination half-lives (t1/2) of FGFC1 were 21.51±2.17 and 23.22±2.11min for 10 and 20mg/kg, respectively. AUC0-t were 412.19±19.09, 899.09±35.86?g/mLmin, systemic clearance (CL) was 0.023±0.002, 0.022±0.002 ((mg/kg)/(?g/mL)/min) and the mean residence time (MRT) was 10.15±0.97, 9.65±1.40min at 10 and 20mg/kg, respectively. No significant differences were observed in the systemic clearance and mean residence time at the tested doses, suggesting linear pharmacokinetics in rats. Tissue distribution data reveal that FGFC1 distributed rapidly in most tissues except the brain and that the highest concentration of the drug was in the liver. In the small intestine, FGFC1 initially increased and then declined, but remained comparatively high 60min after administration, suggesting that enterohepatic circulation may exist. PMID:24216275

  3. Incidence of intravenous contrast extravasation: increased risk for patients with deep brachial catheter placement from the emergency department.

    PubMed

    Hardie, Andrew D; Kereshi, Borko

    2014-06-01

    Deep brachial intravenous catheter (IV) placement can be performed in emergency department patients with difficult vascular access, but the safety of deep brachial IV for iodinated contrast administration has not been assessed. This study compares the relative risk for extravasation of deep brachial IV compared with antecubital IV during power injected computed tomography (CT) examinations. A departmental practice quality improvement was performed to assess the rate of IV extravasation for all CT examinations during a 1 year period. De-identified data was analyzed with a waiver of informed consent to identify the rate and relative risk of iodinated contrast extravasation by catheter type. A total of 10,750 injections were performed, with 82 extravasation events (0.8 %). There were 51 extravasations of antecubital IV from approximately 8,599 placed (0.6 %). For 123 deep brachial IV placed, there were eight extravasations (6.5 %). The relative risk of a deep brachial IV extravasation was 9.4 compared to 0.4 for antecubital placement. Deep brachial IV demonstrated a markedly higher rate of contrast extravasation than antecubital IV. For power injected iodinated contrast administration, it is recommended to avoid the use of deep brachial IV whenever possible. PMID:24395398

  4. Intravenous gammaglobulin for immunodeficiency: report from The European Group for Immunodeficiencies (EGID).

    PubMed Central

    1986-01-01

    Physicians treating patients with antibody deficiency now have a choice between intravenous (IVIG) and intramuscular immunoglobulin therapy. The published comparative trials suggest that (IVIG) is superior, and this is supported by numerous anecdotal observations. Reactions during infusions are no longer a major problem, but there is concern over the transmission of viruses, particularly those causing non-A non-B hepatitis. Having solved the technical difficulties of bulk manufacture of IgG concentrates for intravenous use, our attention should now be directed towards preventing viral contamination by both modifying the manufacturing processes and screening the donors for evidence of disease. PMID:2430746

  5. Intravenous pentamidine for Pneumocystis carinii/jiroveci pneumonia prophylaxis in pediatric transplant patients.

    PubMed

    Clark, Abigail; Hemmelgarn, Trina; Danziger-Isakov, Lara; Teusink, Ashley

    2015-05-01

    SMX/TMP is the current gold standard for prophylaxis against PCP in immunocompromised pediatric patients. Currently, there are several second-line options for prophylaxis but many, including intravenous (IV) pentamidine, have not been reported to be as effective or as safe as SMX/TMP in the pediatric transplant population. This study is to determine the efficacy and safety of IV pentamidine in preventing PCP in pediatric transplant patients. A retrospective chart review was conducted to evaluate all transplant patients that received at least one dose of IV pentamidine from January 2010 to July 2013. The primary outcome, IV pentamidine efficacy, was evaluated by the incidence of PCP diagnosis for 28 days after the last dose of IV pentamidine if patient was transitioned to another agent for PCP prophylaxis. Patients on IV pentamidine for entire course of PCP prophylaxis were followed at least six months after discontinuation of IV pentamidine. The safety of IV pentamidine was assessed by the incidence of adverse events leading to pentamidine discontinuation. All data were analyzed using descriptive statistics. All transplant patients at CCHMC who had received IV pentamidine were reviewed, and 333 patients met inclusion criteria. The overall incidence of PCP was found to be 0.3% for pediatric transplant patients on pentamidine. Pentamidine was found to be safe, and the incidence of adverse events leading to discontinuation was 6% with the most common reason being tachycardia 2.1%. IV pentamidine is safe and effective as PCP prophylaxis in pediatric transplant patients with a PCP breakthrough rate of 0.3% (1 of 333 patients), and only 20 adverse events led to discontinuation. We recommend that IV pentamidine be considered as a second-line option in pediatric transplant patients who cannot tolerate SMX/TMP. PMID:25712369

  6. Intravenous sildenafil in the management of pulmonary hypertension associated with congenital diaphragmatic hernia.

    PubMed

    Bialkowski, Anja; Moenkemeyer, Florian; Patel, Neil

    2015-04-01

    Background?Pulmonary artery hypertension (PAH) is a significant cause of morbidity and mortality in infants with congenital diaphragmatic hernia (CDH). The phosphodiesterase-5 inhibitor sildenafil may be beneficial as a pulmonary vasodilator in CDH. Use of oral preparations of sildenafil may be restricted by feeding delays and intolerance. This study assessed the cardiorespiratory effects of a newly available intravenous (IV) preparation of sildenafil in CDH. Objectives?The objective of the article is to assess the acute effects of IV sildenafil infusion on myocardial function, pulmonary artery pressure (PAP), and oxygenation in infants with CDH. Methods?Retrospective case review of infants with CDH who received continuous IV sildenafil. Physiological and echocardiographic data were reviewed to obtain oxygenation index (OI), PAP, patent ductus arteriosus (PDA) flow, myocardial tissue Doppler velocities, and right ventricular output (RVO) at 48 hours presildenafil, and at 24 to 48 hours and 72 to 96 hours after commencing IV sildenafil. Results?A total of nine infants received IV sildenafil at a dose of 100 to 290 ?g/kg/h after CDH repair but before enteral feeding. Pre-IV sildenafil PAP was???systemic blood pressure in all infants, systolic and diastolic right ventricular myocardial velocities were impaired. After 72 to 96 hours of IV sildenafil, OI and Fio 2 were significantly reduced. Ratio of right-to-left to left-to-right PDA flow was?>?1 pre-IV sildenafil and?IV sildenafil. Conclusions?IV sildenafil infusion was associated with improved oxygenation. Prospective trials of IV sildenafil are required to determine effects on longer term outcome. PMID:24163194

  7. Illicit cocaine use patterns in intravenous-naive cocaine users following investigational intravenous cocaine administration

    Microsoft Academic Search

    Marc J. Kaufman; Jonathan M. Levin; Thellea J. Kukes; Rosemond A. Villafuerte; John Hennen; Scott E. Lukas; Jack H. Mendelson; Perry F. Renshaw

    2000-01-01

    This study evaluated whether cocaine use patterns changed following investigational intravenous cocaine administration to intravenous-naive cocaine users. Subjects were respondents to a follow-up survey who had participated in one to three intravenous double-blind cocaine (0.2 or 0.4 mg\\/kg) administration studies. The group included healthy men (n=17) and women (n=8) with histories of occasional cocaine use (lifetime self-reported use of 12±12

  8. The analgesic effect of dexketoprofen when added to lidocaine for intravenous regional anaesthesia: a prospective, randomized, placebo-controlled study.

    PubMed

    Yurtlu, S; Hanci, V; Kargi, E; Erdo?an, G; Köksal, B G; Gül, ?; Okyay, R D; Ayo?lu, H; Turan, I Ö

    2011-01-01

    This prospective, randomized, placebo-controlled study evaluated the effects of dexketoprofen as an adjunct to lidocaine in intravenous regional anaesthesia (IVRA) or as a supplemental intravenous (i.v.) analgesic. Patients scheduled for elective hand or forearm soft-tissue surgery were randomly divided into three groups. All 45 patients received 0.5% lidocaine as IVRA. Dexketoprofen was given either i.v. or added into the IVRA solution and the control group received an equal volume of saline both i.v. and as part of the IVRA. The times of sensory and motor block onset, recovery time and postoperative analgesic consumption were recorded. Compared with controls, the addition of dexketoprofen to the IVRA solution resulted in more rapid onset of sensory and motor block, longer recovery time, decreased intra- and postoperative pain scores and decreased paracetamol use. It is concluded that coadministration of dexketoprofen with lidocaine in IVRA improves anaesthetic block and decreases postoperative analgesic requirements. PMID:22117995

  9. Successful recanalization with multimodality endovascular interventional therapy in acute ischemic stroke

    PubMed Central

    Jongsathapongpan, Amorn; Raumthanthong, Anuchit; Muengtaweepongsa, Sombat

    2014-01-01

    Stroke is an important cause of death and disability in adults. However, effective treatments for patients with acute ischemic stroke are limited. Intravenous recombinant tissue plasminogen activator (iv rtPA) within 4.5 h after onset has been approved as a standard treatment for patients with acute ischemic stroke. However, due to time constraints, less than one percent of acute ischemic stroke patients in Thailand are able to obtain iv rtPA. Although endovascular interventional therapy has not yet been approved as standard treatment in acute ischemic stroke, it is the one of the potentially effective treatment options. There are several reliable methods of endovascular therapy for acute ischemic stroke patients. Endovascular interventional therapy has rarely been done in Thailand. We report seven patients with successful recanalization after endovascular treatment in acute large vessel stroke from a single stroke center in Thailand. Patient screening and selection with multimodal imaging protocol and multimodality methods of endovascular interventional therapy are described. PMID:24653991

  10. Intravenous iron in a primary-care clinic.

    PubMed

    Maslovsky, I

    2005-04-01

    The preferable route of iron delivery for most iron-deficient patients is oral. Parenteral iron therapy is used in patients who cannot tolerate oral iron or in cases in which oral iron is not sufficiently effective. The most frequent indications for parenteral iron therapy are unbearable gastrointestinal side effects induced by oral iron itself, worsening of inflammatory bowel disease symptoms, insufficient intestinal absorption, renal failure-caused anemia that is treated with erythropoietin, and unresolved ongoing bleeding, which would cause the acceptable oral doses of iron therapy to be exceeded. The serious adverse effects of iron dextran that was used in the past could explain the reluctance of medical personnel to prescribe this effective treatment. Patients with iron deficiency anemia were treated with intravenous iron in a primary care clinic. The iron gluconate was given in a dosage of 62.5 mg diluted in 150 mL of normal saline and was infused intravenously over 30 min, while iron sucrose was given in a dosage of 100 mg diluted in the same volume of normal saline and given at the same rate. In total, 724 infusions were administered to 57 patients. Iron sucrose was used in 628 infusions, and iron gluconate was used in the remaining 96. The frequency of the infusion treatments depended on the underlying disease and ranged from three times a week to once a month. Adverse effects were seldom observed and were minor in patients receiving iron gluconate, and were not registered at all in patients treated with iron sucrose. Two cases of flushing with paresthesias occurred. Slowing the infusion rate successfully eliminated these side effects. One case of hypotension was treated successfully with 500 cc of normal saline infusion. One case of dropout occurred, due to the patient's refusal to cooperate. No anaphylactic reactions were observed. Iron gluconate and iron sucrose are effective and safe for use in primary care clinics. The risk of adverse effects is low. PMID:15795917

  11. Endovascular Therapy in Hyperacute Ischaemic Stroke: History and Current Status

    PubMed Central

    Mortimer, Alex M.; Bradley, Marcus D.; Renowden, Shelley A.

    2013-01-01

    Summary This is a literature review on to the use of endovascular therapy in hyperacute ischaemic stroke secondary to large vessel occlusion (LVO). The prognosis for LVO is generally poor and the efficacy of intravenous tissue plasminogen activator (IV TPA) in the treatment of this subtype of stroke is questionable. It is well documented that recanalisation is associated with improved outcomes but IV TPA has limited efficacy in LVO recanalisation and the complication rates are higher for IV TPA in this stroke subset. Improved recanalisation rates have been demonstrated with intra-arterial TPA and first and second generation mechanical techniques but the rate of favourable outcome has not overtly mirrored this improvement. Several controversial trials using these early techniques have recently been published but fail to reflect modern practice which centres on the use of stent-retriever technology. This has been proven to be superior to older techniques. Not only are recanalisation rates higher, but the speed of recanalisation is greater and clinical results are improved. Multiple observational studies demonstrate consistently high rates of LVO recanalisation; TICI 2b/3 in the order of 65-95% and, rates of favourable outcome (mRS 0-2) in the order of 55% (42.5-77%) in clinically moderate to severe stroke with complicating symptomatic haemorrhage in the order of 1.5-15%. A major factor determining outcome is time to treatment but success has been demonstrated using these devices with bridging therapy, after IV TPA failure or as a stand-alone treatment. PMID:24355158

  12. Home intravenous insulin therapy to avert a diabetic ketoacidosis crisis

    Microsoft Academic Search

    Lynn Moeser; Andrea I. Lampert

    1992-01-01

    Diabetic ketoacidosis (DKA) is an emergency condition that generally requires diagnosis and treatment in a hospital emergency department. This article presents a case study of an alternate treatment choice for those patients who are knowledgeable of the signs of an impending DKA episode. A case study illustrating multidisciplinary collaboration is pre sented with a sample care plan and flowchart.

  13. Hypothesized cause of delayed hemolysis associated with intravenous artesunate.

    PubMed

    Clark, Robert L

    2014-02-01

    In recent publications, investigators described cases in which there was a delayed hemolysis following intravenous (IV) artesunate treatment. The delayed hemolysis event occurred at the nadir of blood hemoglobin concentration, i.e., at the time when blood hemoglobin concentration was switching from a progressive decline to a progressive increase. It is hypothesized that this nadir indicates the time when red cell production is resuming after having been arrested, the delayed hemolysis event is due to lysis of the first (aberrant) reticulocytes released once production is resumed and, therefore, that the hemolysis signals the resumption of red cell production. Since this delayed hemolysis has not been associated with a significant decrease in blood hemoglobin, the hemolytic event is not of particular concern even if it could be attributed to artesunate. More important than this hemolysis event was the preceding progressive anemia that lasted for up to 19 days. Both a decrease in reticulocyte production and a shortened life span of previously infected red cells likely contributed to the anemia. The question that remains to be answered is whether the progressive anemia that lasted 2-3 weeks in these patients was attributable solely to their severe malaria or was possibly enhanced and prolonged by the high plasma concentrations of artesunate associated with IV administration. Controlled clinical studies addressing this question may be needed. PMID:24370269

  14. [Treatment of juvenile pemphigus vulgaris with intravenous immunoglobulins].

    PubMed

    Szép, Z; Danilla, T; Buchvald, D

    2005-01-01

    Juvenile pemphigus vulgaris (JPV) is a rare autoimmune disease. It is treated by different immunosuppressive drugs, which may have serious side effects. Such problems are most apparent in the therapy of children and adolescents. The use of intravenous immunoglobulins (IVIG) is a safe and effective method and therefore it can replace or at least postpone the initiation of the combined immunosuppressive therapy. The article reports experience with the IVIG therapy of severe JPV in 16-year-old female patient. The double combination of IVIG and prednisone was used. IVIG were administered in a dose of 400 mg/kg/day during three consecutive days with the intervals of 1-2 months. Totally 5 cycles were applied. The therapeutic effect was excellent, it started within few days, but it was only temporary and lasted for 1-2 months. IVIG therapy enabled the dose of prednisone to be reduced from 50 mg/day to 15 mg/day. Following the cessation of IVIG, the double combination therapy of prednisone and azathioprine was initiated, but it was unsuccessful in controlling the disease. Remission of JPV achieved with triple combination of prednisone (25 mg/day), azathioprine (100 mg/day) and dapsone (50 mg/day) was comparable to that of IVIG and prednisone combination. On the basis of their positive experience the authors recommend to use IVIG also for cases of childhood and juvenile pemphigus, in which this therapy can delay the need for administration of immunosuppressive drugs with potential of serious adverse effects. PMID:16279438

  15. Pharmacokinetics and Bioavailability of a Therapeutic Enzyme (Idursulfase) in Cynomolgus Monkeys after Intrathecal and Intravenous Administration

    PubMed Central

    Xie, Hongsheng; Chung, Jou-Ku; Mascelli, Mary Ann; McCauley, Thomas G.

    2015-01-01

    Intravenous enzyme replacement therapy with iduronate-2-sulfatase is an approved treatment for Hunter syndrome, however, conventional intravenous delivery cannot treat the neurologic manifestations of the disease due to its limited central nervous system penetration. Intrathecal administration of iduronate-2-sulfatase for delivery to the central nervous system is currently under investigation. The objective of this study was to evaluate the pharmacokinetics of idursulfase in the central nervous system of cynomolgus monkeys (Macaca fasicularis) after intravenous and intrathecal administration. Twenty-seven monkeys, treatment-naïve to enzyme replacement therapy, were placed into 4 groups according to body weight: Group 1 was administered 0.5 mg/kg idursulfase intravenously, Groups 2–4 were administered an intrathecal formulation (1-, 10-, and 30-mg doses). Blood samples and cerebrospinal fluid (sampled at the cisterna magna or lumbar level) were collected at the same time points for 72 hours post dosing. Following intravenous administration, a high maximum serum concentration and rapid distribution of iduronate-2-sulfatase out of the central compartment were observed (elimination half-life: 4.3 hours). Iduronate-2-sulfatase exposure in the cerebrospinal fluid was limited, suggesting intravenous administration provided minimal penetration of the blood–brain barrier. Following intrathecal administration, a high maximum observed concentration was immediately noted and elimination half-life ranged between 7.8–10 hours and 5.9–6.7 hours (cisterna magna and lumbar sampling, respectively). Cerebrospinal fluid pharmacokinetic profiles at different doses of iduronate-2-sulfatase were similar and the dose/exposure relationship was proportional. After intrathecal administration, movement of iduronate-2-sulfatase from cerebrospinal fluid to serum was observed (systemic bioavailability was 40–83%). The clear penetration of iduronate-2-sulfatase into the cerebrospinal fluid and the dose response suggest that intrathecal delivery of iduronate-2-sulfatase may be suitable for treating the central nervous system manifestations associated with Hunter syndrome. PMID:25836678

  16. Chronopharmacology of intravenous and oral modified release verapamil

    PubMed Central

    Dilger, Karin; Eckhardt, Klaus; Hofmann, Ute; Kucher, Klaus; Mikus, Gerd; Eichelbaum, Michel

    1999-01-01

    Aims Using a stable isotope technique which allows simultaneous and differential measuring of orally and intravenously administered drugs we compared the pharmacokinetics and pharmacodynamics of unlabelled modified release verapamil p.o. (steady state) and deuterated verapamil i.v. (single dose) following morning and evening administration. Methods Twelve female and 12 male healthy volunteers were studied in a randomized, crossover design. During the last day of each treatment period (day 6 and day 10) pharmacokinetics and pharmacodynamics (PR interval) of verapamil were assessed; 1 h before ingestion of a new R/S-verapamil 240 mg modified release formulation (08.00 h vs 20.00 h) a single dose of 10 mg d7-R/S-verapamil was administered intravenously. Serum levels of unlabelled and labelled R/S-verapamil were measured by gas chromatography/mass spectrometry. In selected samples of serum which were chosen at tmin,po and tmax,po the enantiomers were separated by chiral high-performance liquid chromatography in order to calculate R- to S-verapamil serum concentration ratios. Results We observed no significant differences in pharmacokinetics (AUCpo, Cmax, tmax, CLo, F and R/S enantiomer ratio) between morning and evening treatment with modified release verapamil and there was no influence of time of dosing on mean prolongation of PR interval. AUCiv, CL, Vss and d7-R/d7-S enantiomer ratio following verapamil i.v. did not show circadian variation. t1/2 was slightly but statistically significantly increased after the morning infusion. PR-prolongation was significantly greater after verapamil i.v. in the morning than in the evening. The 90% confidence intervals of the differences between morning and evening administration in AUCpo, Cmax and AUCiv were within the equivalence range of 0.8–1.25. Conclusions Time of dosing has no significant influence on pharmacokinetics and pharmacodynamics of this new modified release formulation of verapamil. Circadian variation in presystemic metabolism of verapamil was not observed. PMID:10233206

  17. Fosaprepitant Dimeglumine, Palonosetron Hydrochloride, and Dexamethasone in Preventing Nausea and Vomiting Caused by Cisplatin in Patients With Stage III or Stage IV Head and Neck Cancer Undergoing Chemotherapy and Radiation Therapy

    ClinicalTrials.gov

    2013-05-07

    Nausea and Vomiting; Stage III Squamous Cell Carcinoma of the Hypopharynx; Stage III Squamous Cell Carcinoma of the Larynx; Stage III Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage III Squamous Cell Carcinoma of the Nasopharynx; Stage III Squamous Cell Carcinoma of the Oropharynx; Stage IV Squamous Cell Carcinoma of the Hypopharynx; Stage IV Squamous Cell Carcinoma of the Larynx; Stage IV Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage IV Squamous Cell Carcinoma of the Nasopharynx; Stage IV Squamous Cell Carcinoma of the Oropharynx

  18. Vancomycin concentration in synovial fluid: direct injection into the knee vs. intravenous infusion.

    PubMed

    Roy, Marcel E; Peppers, Michael P; Whiteside, Leo A; Lazear, Renée M

    2014-03-01

    The purpose of this study was to measure joint and serum levels of vancomycin following intra-articular (IA) or intravenous (IV) administration, and to compare the concentrations achieved in the joint fluid. IA vancomycin was only used to treat revision total knee arthroplasty (TKA) due to infection, while IV vancomycin was used as a prophylactic agent in primary and revision TKA. Both IA and IV vancomycin achieved therapeutic levels in the synovial fluid of the knee, but IA delivery of vancomycin resulted in peak levels that were many orders of magnitude higher, and also resulted in therapeutic serum levels. The half-life of IA-delivered vancomycin was just over three hours, and trough levels remained therapeutic in the joint and in serum for 24hours after IA injection. PMID:24095208

  19. Evaluation of Intravenous Medication Errors with Smart Infusion Pumps in an Academic Medical Center

    PubMed Central

    Ohashi, Kumiko; Dykes, Patricia; McIntosh, Kathleen; Buckley, Elizabeth; Wien, Matt; Bates, David W.

    2013-01-01

    While some published research indicates a fairly high frequency of Intravenous (IV) medication errors associated with the use of smart infusion pumps, the generalizability of these results are uncertain. Additionally, the lack of a standardized methodology for measuring these errors is an issue. In this study we iteratively developed a web-based data collection tool to capture IV medication errors using a participatory design approach with interdisciplinary experts. Using the developed tool, a prevalence study was then conducted in an academic medical center. The results showed that the tool was easy to use and effectively captured all IV medication errors. Through the prevalence study, violation errors of hospital policy were found that could potentially place patients at risk, but no critical errors known to contribute to patient harm were noted. PMID:24551395

  20. Medication safety: does intravenous acetaminophen promote perioperative hypothermia for total hip arthroplasty?

    PubMed

    Visnjevac, Ognjen; Kocz, Remek; Visnjevac, Tanja; Annam, Sandeep Kumar; Toufexis, George

    2014-11-01

    As an effective antipyretic with a yet-unknown mechanism-of-action, intravenous (IV) acetaminophen use for total hip arthroplasties (THA) may worsen perioperative hypothermia when combined with the known hypothermia-inducing effects of general anesthesia (GA), affecting wound healing, recovery times, and patient satisfaction. This retrospective chart review of primary THA cases compared perioperative heat loss for patients who received IV acetaminophen with GA (group A, n = 74) to those receiving GA alone (group B, n = 197). All patients received forced-air warming blankets. Neuraxial anesthesia cases were excluded. No significant temperature differences existed between group A (-0.33°C, SD = 0.36) and group B (-0.30°C, SD = 0.34, P > 0.05). IV acetaminophen use for THA does not appear to promote hypothermia under general anesthesia. PMID:25103465

  1. HEADPLAY Personal Cinema System Facilitates Intravenous Cannulation in Children: A Randomized Controlled Trial.

    PubMed

    Lim, Evangeline; Fabila, Teddy; Sze Ying, Thong; Tan, Josephine

    2013-01-01

    HEADPLAY personal cinema system (PCS) is a portable visual headset/visor through which movie clips may be viewed. We studied the use of HEADPLAY PCS as a distraction tool in facilitating intravenous cannulation in children undergoing anaesthesia. 60 children were enrolled into the study and randomized into 2 groups. EMLA local anaesthetic cream was used to reduce the pain associated with intravenous cannulation. Children in group 1 wore the HEADPLAY visor whereas children in group 2 were subject to conventional distraction therapy. Children were asked to rate their anxiety, pain, and satisfaction scores after intravenous cannulation. Periprocedural anxiety was also determined using the modified Yale Preoperative Anxiety Scale (mYPAS). There were no statistically significant differences in terms of pain and anxiety scores between the 2 groups. Although the satisfaction score of the children in the HEADPLAY PCS group was marginally higher compared to the conventional group, this did not hit statistical significance. 86.6% of children in group 1 reported that they would want to use the visor again for their next intravenous cannulation. We conclude that HEADPLAY PCS is a distraction tool that is acceptable to most children and can contribute towards satisfaction of the intravenous cannulation process in children. PMID:23840223

  2. Potent effects of aerosol compared with intravenous treprostinil on the pulmonary circulation.

    PubMed

    Sandifer, Brett L; Brigham, Kenneth L; Lawrence, E Clinton; Mottola, David; Cuppels, Chris; Parker, Richard E

    2005-12-01

    Inhaled vasodilator therapy for pulmonary hypertension may decrease the systemic side effects commonly observed with systemic administration. Inhaled medications only reach ventilated areas of the lung, so local vasodilation may improve ventilation-perfusion matching and oxygenation. We compared the effects of intravenous vs. aerosolized treprostinil on pulmonary and systemic hemodynamics in an unanesthetized sheep model of sustained acute pulmonary hypertension. Acute, stable pulmonary hypertension was induced in instrumented unanesthetized sheep by infusing a PGH(2) analog, U-44069. The sheep were then administered identical doses of treprostinil either intravenously or by aerosol. Systemic and pulmonary hemodynamics were recorded during each administration. Both intravenous and aerosol delivery of treprostinil reduced pulmonary vascular resistance and pulmonary arterial pressure, but the effect was significantly greater with aerosol delivery (P < 0.05). Aerosol delivery of treprostinil had minimal effects on systemic hemodynamics, whereas intravenous delivery increased heart rate and cardiac output and decreased left atrial pressure and systemic blood pressure. Aerosol delivery of the prostacyclin analog treprostinil has a greater vasodilatory effect in the lung with minimal alterations in systemic hemodynamics compared with intravenous delivery of the drug. We speculate that this may result from treprostinil stimulated production of vasodilatory mediators from pulmonary epithelium. PMID:16141385

  3. Incidence and Risk Factors of Postoperative Nausea and Vomiting in Patients with Fentanyl-Based Intravenous Patient-Controlled Analgesia and Single Antiemetic Prophylaxis

    PubMed Central

    Choi, Jong Bum; Shim, Yon Hee; Lee, Youn-Woo; Lee, Jeong Soo; Choi, Jong-Rim

    2014-01-01

    Purpose We evaluated the incidence and risk factors of postoperative nausea and vomiting (PONV) in patients with fentanyl-based intravenous patient-controlled analgesia (IV-PCA) and single antiemetic prophylaxis of 5-hydroxytryptamine type 3 (5 HT3)-receptor antagonist after the general anesthesia. Materials and Methods In this retrospective study, incidence and risk factors for PONV were evaluated with fentanyl IV-PCA during postoperative 48 hours after various surgeries. Results Four hundred-forty patients (23%) of 1878 had showed PONV. PCA was discontinued temporarily in 268 patients (14%), mostly due to PONV (88% of 268 patients). In multivariate analysis, female, non-smoker, history of motion sickness or PONV, long duration of anesthesia (>180 min), use of desflurane and intraoperative remifentanil infusion were independent risk factors for PONV. If one, two, three, four, five, or six of these risk factors were present, the incidences of PONV were 18%, 19%, 22%, 31%, 42%, or 50%. Laparoscopic surgery and higher dose of fentanyl were not risk factors for PONV. Conclusion Despite antiemetic prophylaxis with 5 HT3-receptor antagonist, 23% of patients with fentanyl-based IV-PCA after general anesthesia showed PONV. Long duration of anesthesia and use of desflurane were identified as risk factors, in addition to risk factors of Apfel's score (female, non-smoker, history of motion sickness or PONV). Also, intraoperative remifentanil infusion was risk factor independent of postoperative opioid use. As the incidence of PONV was up to 50% according to the number of risk factors, risk-adapted, multimodal or combination therapy should be applied. PMID:25048507

  4. Final inline filtration for intravenous infusions: a prospective hospital study.

    PubMed

    Allcutt, D A; Lort, D; McCollum, C N

    1983-02-01

    Phlebitis is the most common complication of intravenous therapy affecting more than 50 per cent of infusions. Particles in or added to infusions have been implicated, hence a filter with pore size of 0.2 micron containing both hydrophobic and hydrophilic elements (Pall Biomedical) has been evaluated. All infusions of likely duration greater than 48 h, set up in a 2-month period at this hospital, were randomized to filter or identical dummy. The endpoints and statistical power of the study were determined at the outset. Of the 226 infusions randomized, 32 failed within 24 h and were excluded leaving 194 of whom 93 had dummy and 101 filter. Only 38 infusions with dummy survived until no longer required compared to 63 infusions with filter (chi 2 = 7.68, P less than 0.01). Analysed by life table, the trend for filtered infusions to survive longer failed to achieve statistical significance, but inline filtration prolonged the phlebitis-free survival of infusions (P less than 0.01). These benefits were most marked in the 49 infusions where antibiotics were administered via the drip site. Inline filtration delays the onset of phlebitis, thus more infusions survive until they are no longer required. This effect is not sufficiently strong to institute an overall hospital policy but filters may be indicated in patients requiring intravenous antibiotics. PMID:6824894

  5. Comparison of oral and intravenous Alfacalcidol in chronic hemodialysis patients

    PubMed Central

    2014-01-01

    Background Activated vitamin D is the mainstay of treatment for secondary hyperparathyroidism (SHPT) in chronic hemodialysis patients. However, the optimal route of administration is still debated. The aim of our study was to compare efficacy of oral vs intravenous (IV) administration of alfacalcidol in hemodialysis. A secondary objective was to determine the cost-effectiveness advantage of oral administration. Methods Eighty-eight chronic hemodialysis patients receiving IV alfacalcidol three times a week were included in the study. All were switched to the same dose of alfacalcidol given orally three times a week during the hemodialysis session. A budget impact analysis was performed. Results Mean patient age was 64 years old and 43% were males. The mean alfacalcidol dose administered was 2.1 ?g three times a week. After three months, serum parathormone (PTH) levels decreased from 80 to 59 pmol/L (p =?0.001) and total serum calcium levels increased from 2.34 to 2.40 mmol/L (p =?0.002). After six months, total serum calcium levels were still significantly higher. Alfacalcidol dosage was significantly decreased during study period; the mean reduction was 0.44 ?g per dose. Finally, oral administration was associated with an annual cost reduction of 197 678$CAN and an annual nursing time reduction of 25 days. Conclusion Our findings support that switching IV to oral administration of alfacalcidol during hemodialysis sessions may lead to a similar control of SHPT with lower doses of activated vitamin D. This is a good strategy for optimizing compliance and may allow a dose reduction because of a greater efficacy to suppress PTH. Oral administration also has significant cost-effectiveness advantages. PMID:24495277

  6. The role of intravenous iron in the treatment of anemia in cancer patients

    PubMed Central

    2012-01-01

    Anemia is a major cause of morbidity in cancer patients resulting in poor physical performance, prognosis and therapy outcome. Initially, erythropoietin-stimulating agents (ESAs) were supposed to be the treatment of choice but about one third of patients turned out to be nonresponders and meta-analyses provided evidence of an increased risk of mortality if used excessively. This along with the successful use of intravenous iron for anemia in patients with chronic kidney disease prompted seven clinical studies evaluating the efficacy of intravenous iron as an adjunct to ESAs and four additional studies using intravenous iron only for anemia in cancer patients. These studies confirmed a superior response if ESAs are combined with intravenous iron and revealed iron only to be a useful option in patients with mild and absolute iron deficiency (AID). Currently, best treatment decisions for anemia in cancer might be based on measurements of serum ferritin (SF), transferrin saturation (TSAT), soluble transferrin receptor (sTfR), ferritin index (FI = sTfR/log SF), hypochromic reticulocytes (CHR) and C-reactive protein (CRP). However, there is still an urgent need for trials investigating diagnostic approaches to optimize therapy of anemia in cancer patients with iron and/or ESAs. PMID:23556124

  7. Detection of exhaled hydrogen sulphide gas in rats exposed to intravenous sodium sulphide

    PubMed Central

    Insko, Michael A; Deckwerth, Thomas L; Hill, Paul; Toombs, Christopher F; Szabo, Csaba

    2009-01-01

    Background and purpose: Sodium sulphide (Na2S) disassociates to sodium (Na+) hydrosulphide, anion (HS?) and hydrogen sulphide (H2S) in aqueous solutions. Here we have established and characterized a method to detect H2S gas in the exhaled breath of rats. Experimental approach: Male rats were anaesthetized with ketamine and xylazine, instrumented with intravenous (i.v.) jugular vein catheters, and a tube inserted into the trachea was connected to a pneumotach connected to a H2S gas detector. Sodium sulphide, cysteine or the natural polysulphide compound diallyl disulphide were infused intravenously while the airway was monitored for exhaled H2S real time. Key results: Exhaled sulphide concentration was calculated to be in the range of 0.4–11 ppm in response to i.v. infusion rates ranging between 0.3 and 1.1 mg·kg?1·min?1. When nitric oxide synthesis was inhibited with N?-nitro-L-arginine methyl ester the amount of H2S exhaled during i.v. infusions of sodium sulphide was significantly increased compared with that obtained with the vehicle control. An increase in circulating nitric oxide using DETA NONOate [3,3-bis(aminoethyl)-1-hydroxy-2-oxo-1-triazene] did not alter the levels of exhaled H2S during an i.v. infusion of sodium sulphide. An i.v. bolus of L-cysteine, 1 g·kg?1, and an i.v. infusion of the garlic derived natural compound diallyl disulphide, 1.8 mg·kg?1·min?1, also caused exhalation of H2S gas. Conclusions and implications: This method has shown that significant amounts of H2S are exhaled in rats during sodium sulphide infusions, and the amount exhaled can be modulated by various pharmacological interventions. PMID:19422378

  8. Hereditary hemorrhagic telangiectasia treated with low dose intravenous bevacizumab

    PubMed Central

    Wee, Jee Wan; Jeon, Young Woo; Eun, Jun Young; Kim, Han Jo; Bae, Sang Byung

    2014-01-01

    Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disorder that leads to mucocutaneous telangiectasias, epistaxis, and gastrointestinal bleeding. Depending on the severity and manifestation of the disease, various therapeutic modalities have been used, from local bleeding control to surgery or concomitant drug therapy. Several articles under review have presented guidelines for treatment of HHT with bevacizumab as a direct anti-angiogenesis strategy. Still, neither the exact optimal dose nor the minimum effective dose of intravenous bevacizumab in patients with severe HHT has been reported. A 55-year-old man presented with long-standing epistaxis, recent melena, dizziness, and a three-generation family history of chronic epistaxis, anemia, and regular blood transfusions. Treatment with argon plasma coagulation (APC) for the gastrointestinal bleeding failed to raise hemoglobin levels, we considered using the bevacizumab. We report a patient with severe HHT, who was treated with low-dose bevacizumab (2 mg/kg) and improved substantially. PMID:25325040

  9. The intravenous laser blood irradiation in chronic pain and fibromyalgia.

    PubMed

    Momenzadeh, Sirous; Abbasi, Mohammadzaki; Ebadifar, Asghar; Aryani, Mohammadreza; Bayrami, Jafar; Nematollahi, Fatemeh

    2015-01-01

    Intravenous laser blood irradiation was first introduced into therapy by the Soviet scientists EN.Meschalkin and VS.Sergiewski in 1981. Originally this method was developed for the treatment of cardiovascular diseases. Improvement of rheologic properties of the blood as well as improvement of microcirculation and reduction of the area of infarction has been proved. Further, reduction of dysrhythmia and sudden cardiac death was achieved. At first, only the Helium-Neon laser (632.8 nm) was used in this therapy. For that, a power of 1-3mW and a period of exposure of 20-60 minutes were applied. The treatments were carried out once or twice a day up to ten appointments in all1. In the years after, many, and for the most part Russian studies showed that helium-neon laser had various effects on many organs and on the hematologic and immunologic system. The studies were published mainly in Russian which were little known in the West because of decades of political separation, and were regarded with disapproval. Besides clinical research and application for patients, the cell biological basis was developed by the Estonian cell biologist Tiina Karu at the same time. An abstract is to be found in her work "The Science of Low-Power Laser-Therapy" PMID:25699161

  10. Induction of contact sensitivity and antigenic competition by the intravenous administration of contact sensitizers.

    PubMed

    Nakano, Y; Nakano, K

    1981-01-01

    The effect of route of administration of contact sensitizers on the induction of antigenic competition between dinitrofluorobenzene (DNFB) and picryl chloride (PCl) and between oxazolone (Ox) and PCl was investigated. Antigenic competition (depressed contact sensitivity to PCl) was induced not only by painting with DNFB via various routes, such as intravenous (i.v.), oral or subcutaneous routes. Antigenic competition was abolished by the treatment with cyclophosphamide (CY) 4 days after i.v. injection of competing DNFB or Ox, and also by thymectomy 6 weeks prior to the injection of DNFB. These results suggest that thymus-derived suppressor cells may be involved in the antigenic competition induced by the i.v. injection of DNFB. Primary contact sensitivity (CS) was induced by painting of DNFB or Ox and also by i.v. injection of Ox. Although an i.v. injection of DNFB into normal mice did not induce CS, it induced a strong CS in the mice pretreated with CY 2 days prior to the injection of DNFB. Examination on the effect of dose of contact sensitizers on the induction of antigenic competition, primary CS and tolerance by painting or by i.v. injection of DNFB or Ox showed that the degree of antigenic competition has a closer relationship with CS, than with unresponsiveness. PMID:7461721

  11. Intracoronary Versus Intravenous Adenosine-Induced Maximal Coronary Hyperemia for Fractional Flow Reserve Measurements

    PubMed Central

    Khashaba, Ahmed; Mortada, Ayman; Omran, Azza

    2014-01-01

    BACKGROUND Maximal hyperemia is the critical prerequisite for fractional flow reserve (FFR) assessment. Despite intravenous (IV) adenosine currently being the recommended approach, intracoronary (IC) administration of adenosine constitutes a valuable alternative in everyday practice. However, it is surprisingly unclear which IC strategy allows the achievement of FFR values that are comparable to IV adenosine. OBJECTIVES This study sought to compare increasing doses of IC adenosine versus IV adenosine for FFR. METHODS 30 intermediate coronary stenoses undergoing FFR measurement were prospectively and consecutively enrolled. Hyperemia was sequentially induced by bolus of IC adenosine (ADN; 150 ?g) followed by IV adenosine (IVADN) infusion over 3 minutes at dose of (140 ?g/kg/min). FFR values, symptoms, and development of atrioventricular block were recorded. RESULTS 150 ?g doses of IC adenosine were well tolerated and associated with fewer symptoms than IV adenosine. Intracoronary adenosine doses induced a significant decrease of FFR compared with baseline levels (P < 0.01). Among the 6 patients with FFR values less than 0.80 identified by IVADN, 4 were correctly identified also by 150 ?g bolus IC adenosine. Larger randomized studies with cross-over design are necessary to verify the results. CONCLUSIONS This small pilot study suggests that IC adenosine might be an alternative to IV adenosine. Larger randomized studies with a cross-over design are necessary. PMID:24558302

  12. Effects of ketamine-xylazine intravenous bolus injection on cardiovascular function in rabbits

    PubMed Central

    Baumgartner, Christine; Bollerhey, Melanie; Ebner, Johanna; Laacke-Singer, Lién; Schuster, Tibor; Erhardt, Wolf

    2010-01-01

    The direct effects of ketamine-xylazine (KET-XYL) on vascular function have not been investigated in rabbits. The short-term cardiovascular effects of intravenous (IV) KET-XYL bolus injection, therefore, should be investigated using vascular ultrasonography. In this prospective experimental study, KET-XYL anesthesia was induced IV in 9 female New Zealand White rabbits before 3 defined test bolus injections of KET-XYL were given IV. Before and for 10 min after each KET-XYL injection vascular and hemodynamic variables were recorded at the left common carotid artery (ACC) after the 1st injection, and at the abdominal aorta (AA) after the 2nd injection. Echocardiography was performed after the 3rd injection to investigate changes in cardiac parameters. Ketamine-xylazine IV caused a significant increase in vessel diameter at the ACC and AA. Average volumetric flow significantly decreased at the ACC and pulsatility index significantly decreased at the AA. Fractional shortening (FS) and heart rate significantly decreased, while mean arterial blood pressure initially increased. Bolus injections of KET-XYL IV produced a transient vasodilatation at the ACC and AA. Despite central vasodilatation, bradycardia, and decrease of FS and average volumetric flow (VFave), mean arterial blood pressure did not significantly decrease indicating well-preserved cardiovascular compensatory mechanism after the ratio and doses of KET-XYL IV bolus injections used in this study. PMID:20885844

  13. Alkalinisation of prilocaine for intravenous regional anaesthesia.

    PubMed

    Armstrong, P; Brockway, M; Wildsmith, J A

    1990-01-01

    Ten volunteers underwent intravenous regional anaesthesia on two separate occasions using 40 ml prilocaine 0.5% to which was added 5 ml of either saline 0.9% or sodium bicarbonate 8.4%. Addition of sodium bicarbonate decreased the time of onset of loss of sharp touch and temperature sensations and of motor power. Time to full recovery of the arm was slower with the alkalinized solution and nine of the subjects preferred this block. The addition of sodium bicarbonate to prilocaine for intravenous regional anaesthesia may be clinically useful. PMID:2156466

  14. Optimization of Drug Delivery Systems for Intraperitoneal Therapy to Extend the Residence Time of the Chemotherapeutic Agent

    PubMed Central

    De Smet, L.; Ceelen, W.; Remon, J. P.; Vervaet, C.

    2013-01-01

    Intraperitoneal (IP) chemotherapy is an effective way of treating peritoneal carcinomatosis of colorectal origin after complete cytoreduction. Although IP therapy has been already performed for many years, no standardized treatment design has been developed in terms of schedule, residence time, drug, or carrier solution. Because of the fast clearance of the conventional intravenous (IV) drug delivery systems used for IP therapy, a lot of research is performed to optimize IP drug delivery and extend the residence time of the cytotoxic agent in the peritoneal cavity. This paper reviews the recent advances made in drug delivery systems for IP chemotherapy, discussing the use of microparticles, nanoparticles, liposomes, micelles, implants, and injectable depots for IP delivery. PMID:23589707

  15. Effect of intravenous iron sucrose in peritoneal dialysis patients who receive erythropoiesis-stimulating agents for anemia: a randomized, controlled trial.

    PubMed

    Singh, Harmeet; Reed, John; Noble, Sylvia; Cangiano, Jose L; Van Wyck, David B

    2006-05-01

    Although iron therapy is essential to optimize use of erythropoiesis-stimulating agents (ESA), randomized, controlled trials have heretofore been unavailable to evaluate reliably the efficacy of intravenous iron as an adjuvant to ESA treatment in peritoneal dialysis (PD) patients. In a multicenter trial, patients who had anemia, PD-dependent chronic kidney disease, stable ESA therapy, and a broad range of iron status (ferritin < or = 500 ng/ml, transferrin saturation < or = 25%) were randomly assigned to receive either 1 g of iron sucrose intravenously in three divided doses (300 mg over 1.5 h on days 1 and 15, 400 mg over 2.5 h on day 29) or no supplemental iron. No serious adverse drug events occurred after intravenous iron administration. The primary end point, peak hemoglobin increase, was higher (1.3 +/- 1.1 versus 0.7 +/- 1.1, mean +/- SD; P = 0.0028), and anemia intervention (transfusion, increase in ESA dose, or intravenous iron therapy not called for in protocol) occurred later (P = 0.0137) and less often in intravenous iron-treated patients compared with untreated control subjects (one of 66 [1.3%] versus five of 30 [16.7%]). Among patients who did not require intervention, iron-treated patients showed a calculated net ESA dose decrease compared with untreated control subjects. Baseline iron status did not predict responsiveness to intravenous iron therapy. Intravenous iron sucrose is an effective adjunct to ESA therapy in anemic patients with PD-dependent chronic kidney disease and is administered safely as 300 mg over 1.5 h or 400 mg over 2.5 h. Evidence of iron deficiency at baseline is not required to demonstrate intravenous iron efficacy. PMID:17699248

  16. Drug evaluation: ADA-transduced hematopoietic stem cell therapy for ADA-SCID.

    PubMed

    Taupin, Phillippe

    2006-06-01

    San Raffaele Telethon Institute for Gene Therapy is developing an adenosine deaminase-transduced hematopoietic stem cell therapy for the potential intravenous treatment of adenosine deaminase deficiency in severe combined immunocompromised individuals. PMID:16752313

  17. Comparison between intravenous and intraarterial contrast injections for dynamic 3D MRI of liver tumors in the VX2 rabbit model

    Microsoft Academic Search

    Andrew C. Larson; Thomas K. Rhee; Jie Deng; Dingxin Wang; Kent T. Sato; Riad Salem; Tatjana Paunesku; Gayle Woloschak; Mary F. Mulcahy; Debiao Li; Reed A. Omary

    2006-01-01

    Purpose: To test the hypothesis that catheter-directed in- traarterial (IA) contrast agent injection increases tumor enhancement and conspicuity compared to intravenous (IV) injection. Materials and Methods: Eight VX2 liver tumors were grown in five rabbits. After positioning a catheter in the hepatic artery, we performed 3D inversion recovery GRE MRI after IA and IV gadopentetate-dimeglumine contrast injections at doses of

  18. Efficacy of repeat intravenous dosing of ondansetron in controlling postoperative nausea and vomiting: a randomized, double-blind, placebo-controlled multicenter trial

    Microsoft Academic Search

    Anthony L. Kovac; Thomas A. O’Connor; Michael H. Pearman; Lance J. Kekoler; Donald Edmondson; Verna L. Baughman; John J. Angel; Christina Campbell; Holly G. Jense; Melinda Mingus; Mohammad B. G. Shahvari; Mary R. Creed

    1999-01-01

    Study Objectives: To compare repeat intravenous (IV) dosing of ondansetron 4 mg with placebo for the treatment of postoperative nausea and vomiting (PONV) in patients for whom prophylactic, preoperative ondansetron 4 mg IV was inadequateDesign: Randomized, double-blind, placebo-controlled study.Setting: Ten outpatient surgical centers in the United States.Patients: 2,199 male and female ASA physical status I, II, and III patients ?12

  19. Intravenous lorazepam versus dimenhydrinate for treatment of vertigo in the emergency department: A randomized clinical trial

    Microsoft Academic Search

    Keith A. Marill; Matthew J. Walsh; Brian K. Nelson

    2000-01-01

    Study Objective: To determine whether lorazepam is more effective than dimenhydrinate in relieving the symptom of vertigo in the emergency department setting. Methods: A prospective, randomized, double-blind trial of intravenous lorazepam versus dimenhydrinate therapy was conducted in the ED of a county-owned, university-affiliated hospital. All adult patients who presented between January 24, 1998, and May 23, 1999, with the symptom

  20. Polymeric Micelles for Neoadjuvant Cancer Therapy and Tumor-Primed Optical Imaging

    PubMed Central

    Cho, Hyunah; Kwon, Glen S.

    2013-01-01

    Poly(ethylene glycol)-block-poly(D,L-lactic acid) (PEG-b-PLA) micelles act as a 3-in-1 nanocontainer for three poorly water-soluble drugs–paclitaxel, 17-allylamino-17-demethoxygelda-namycin, and rapamycin (PTX/17-AAG/RAPA)–for cancer therapy. In a LS180 human colon xenograft model, a single intravenous (IV) injection of 3-in-1 PEG-b-PLA micelles reduced tumor volume by 1.6-fold with <10% body weight change. In a second step, IV injection of poly(ethylene glycol)-block-poly(?-caprolactone) (PEG-b-PCL) micelles carrying a carbocyanine dye (1,1?-dioctadecyl tetramethyl indotricarbocyanine iodide (DiR)) after 48 h resulted in a 2.1-fold higher near-infrared (NIR) optical signal from excised solid tumors versus a negative control, presumably due to a reduction in tumor cell density and interstitial tumor pressure. Thus, a tandem of 3-in-1 PEG-b-PLA and PEG-b-PCL micelles could potentially be used for neoadjuvant cancer therapy and tumor-primed NIR optical imaging for intraoperative surgical guidance in oncology, offering a promising multimodal strategy for cancer therapy and imaging. PMID:21999531

  1. Acute Stroke Reperfusion Therapy Trends in the Expanded Treatment Window Era

    PubMed Central

    Asaithambi, Ganesh; Tong, Xin; George, Mary G.; Tsai, Albert W.; Peacock, James M.; Luepker, Russell V.; Lakshminarayan, Kamakshi

    2015-01-01

    Background The American Heart Association/American Stroke Association (AHA/ ASA) recommended an expansion of the time window for acute ischemic stroke (AIS) reperfusion with intravenous (IV) recombinant tissue plasminogen activator (rt-PA) from 3 to 4.5 hours after symptom onset. We examine rates of IV and intraarterial (IA) reperfusion before and after the recommendations to track guideline adoption in community practice. Methods Patients with AIS in the Paul Coverdell National Acute Stroke Registry spanning years 2007-2012 were identified. Trends in rates of IV rt-PA versus IA therapy were examined. Outcomes included symptomatic intracerebral hemorrhage (sICH), in-hospital mortality, ability to ambulate at discharge, and discharge destination. Results From 2007 to 2012, there were 182,235 AIS patients (median age, 72 years; 51.5% women) in the database at the time of analysis. AIS patients receiving IV rt-PA increased significantly from 3.7% in 2007 to 5.1% in 2012 in the ?3 hours time window and from .2% in 2007 to 1.3% in 2012 in the 3-4.5 hours time window (P <.001 for both). There was also a significant increase in the rate of IA therapy between 2007 and 2012 (P <.001). There was a significant decrease in the rate of sICH among patients who received any reperfusion between 2007 and 2012. Conclusions There was a trend for increased utilization of IV rt-PA in the 0-3 hours and the 3-4.5 hours time windows, which began around the same time as the publication of AHA/ASA recommendations in 2009. This increase was associated with an increase in IA treatment rates along with a decrease in overall sICH rates for patients receiving any reperfusion. Key Words: Expanded time window—ischemic stroke—thrombolysis—trend analysis. PMID:25156783

  2. The Intravenous Route to Blood Glucose Control

    E-print Network

    Peppas, Nicholas A.

    The Intravenous Route to Blood Glucose Control A Review of Control Algorithms for Noninvasive by the inability of the pancreas to regulate blood glucose concentration. In- sulin-dependent, or type I, diabetes in poor maintenance of normo- glycemia (defined as the normal condition with blood glucose concentrations

  3. Computer analysis of intravenous glucose tolerance tests

    Microsoft Academic Search

    D. H. Silcock; D. R. Hadden; D. W. Neill

    1972-01-01

    Summary  A computer program which simultaneously calculates glucose disappearance rates after intravenous injection using three different mathematical equations is described. This program has been applied to the results obtained from several groups of pregnant women. The reasons for suggesting that the absolute K value may be preferable on practical grounds are discussed. This program, written in Fortran, is available on application

  4. Intravenous Iron Sucrose Changes the Intraperitoneal Homeostasis

    Microsoft Academic Search

    M. Kupczyk; M. Wanic-Kossowka; D. G. Oreopoulos

    2009-01-01

    Background\\/Aims: Intravenous iron infusion is the accepted way of supplementation of that compound in uremic patients. The aim of the study was to evaluate whether this treatment affects intraperitoneal homeostasis in patients on peritoneal dialysis. Methods: Blood and peritoneal dialysate samples were collected from 10 patients treated with continuous ambulatory peritoneal dialysis who were given 100 mg iron sucrose (IS)

  5. Anemia and iron deficiency in COPD patients: prevalence and the effects of correction of the anemia with erythropoiesis stimulating agents and intravenous iron

    PubMed Central

    2014-01-01

    Background Little is known about iron deficiency (ID) and anemia in Chronic Obstructive Pulmonary Disease (COPD). The purposes of this study were: (i) To study the prevalence and treatment of anemia and ID in patients hospitalized with an exacerbation of COPD. (ii) to study the hematological responses and degree of dyspnea before and after correction of anemia with subcutaneous Erythropoiesis Stimulating Agents (ESAs) and intravenous (IV) iron therapy, in ambulatory anemic patients with both COPD and chronic kidney disease. Methods (i) We examined the hospital records of all patients with an acute exacerbation of COPD (AECOPD) to assess the investigation, prevalence, and treatment of anemia and ID. (ii) We treated 12 anemic COPD outpatients with the combination of ESAs and IV-iron, given once weekly for 5 weeks. One week later we measured the hematological response and the severity of dyspnea by Visual Analogue Scale (VAS). Results (i) Anemia and iron deficiency in hospitalized COPD patients: Of 107 consecutive patients hospitalized with an AECOPD, 47 (43.9%) were found to be anemic on admission. Two (3.3%) of the 60 non-anemic patients and 18 (38.3%) of the 47 anemic patients had serum iron, percent transferrin saturation (%Tsat) and serum ferritin measured. All 18 (100%) anemic patients had ID, yet none had oral or IV iron subscribed before or during hospitalization, or at discharge. (ii) Intervention outpatient study: ID was found in 11 (91.7%) of the 12 anemic ambulatory patients. Hemoglobin (Hb), Hematocrit (Hct) and the VAS scale scores increased significantly with the ESAs and IV-iron treatment. There was a highly significant correlation between the ?Hb and ?VAS; rs?=?0.71 p?=?0.009 and between the ?Hct and ?VAS; rs?=?0.8 p?=?0.0014. Conclusions ID is common in COPD patients but is rarely looked for or treated. Yet correction of the ID in COPD patients with ESAs and IV iron can improve the anemia, the ID, and may improve the dyspnea. PMID:24564844

  6. The safety and efficacy of intravenous ferric carboxymaltose in anaemic patients undergoing haemodialysis: a multi-centre, open-label, clinical study

    PubMed Central

    Covic, Adrian; Mircescu, Gabriel

    2010-01-01

    Background. Patients with chronic kidney disease (CKD) often present with iron depletion and iron deficiency anaemia (IDA) because of frequent blood (and iron) loss. Therapy consists of repletion of iron stores and intravenous (i.v.) iron has become the standard care in this setting. However, older i.v. iron preparations have their limitations. This study primarily investigated the safety, and also the efficacy, of ferric carboxymaltose (FCM), a next-generation i.v. iron formulation, given as a bolus–push injection in patients with CKD undergoing maintenance haemodialysis (HD). Methods. Patients (aged 18–65 years) with IDA undergoing HD received 100–200 mg of iron as FCM via an i.v. bolus–push injection into the HD venous line, two to three times weekly for ?6 weeks. Safety assessments included incidence of adverse events (AEs). Treatment responders were patients attaining ?1.0 g/dl increase in haemoglobin (Hb) from baseline at any time during the study. Enrolled patients (safety population) receiving ?1 dose of study medication were included in the efficacy analyses [intent-to-treat (ITT) population]. Results. Of 163 patients enrolled, 150 (92%) completed the study. The mean ± SD total cumulative dose of iron as FCM administered was 2133.3 ± 57.7 mg. In total, 193 AEs were reported in 89 out of 163 (54.6%) patients. Almost three-quarters of patients (73.6%) received erythropoiesis-stimulating agents (ESAs), but the dose remained stable during the study. Serious AEs occurred in 12 out of 163 (7.4%) patients and two patients died; none of these was considered by the investigator to be related to the study medication. Only five out of 163 (3.1%) patients discontinued study medication due to an AE. Overall, 100 out of 162 (61.7%; ITT population) patients were treatment responders, and mean Hb levels increased from 9.1 ± 1.30 g/dl at baseline to 10.3 ± 1.63 g/dl at follow-up. Conclusions. FCM is well-tolerated and effective in the correction of Hb levels and iron stores in patients with IDA undergoing HD. As changes in anaemia treatment other than i.v. FCM (e.g. increased ESA doses) were not permitted during the study, the clinically relevant increase in Hb in the majority of patients can be solely attributed to efficient iron utilization. The incidence of AEs was as expected for this population. PMID:20190247

  7. Clinical experience with intravenous zoledronic acid in the treatment of male osteoporosis: evidence and opinions

    PubMed Central

    Ruza, Ieva; Mirfakhraee, Sasan; Orwoll, Eric

    2013-01-01

    Osteoporosis frequently remains underrecognized and undertreated in men. Most osteoporosis-related fractures could be prevented if men at risk would be diagnosed, treated, and remained compliant with therapy. Bisphosphonates, the mainstay of osteoporosis treatment, are potent antiresorptive agents that inhibit osteoclast activity, suppress in vivo markers of bone turnover, increase bone mineral density, decrease fractures, and likely improve survival in men with osteoporosis. The focus of the article is on intravenous zoledronic acid, which may be a preferable alternative to oral bisphosphonate therapy in patients with cognitive dysfunction, the inability to sit upright, polypharmacy, significant gastrointestinal pathology or suspected medication noncompliance. Zoledronic acid is approved in the United States (US) and European Union (EU) as an annual 5 mg intravenous infusion to treat osteoporosis in men. The zoledronic acid 4 mg intravenous dose has been studied in the prevention of bone loss associated with androgen deprivation therapy. This article reviews the evidence for zoledronic acid, currently the most potent bisphosphonate available for clinical use, and its therapeutic effects in the treatment of men with osteoporosis. PMID:23904863

  8. Use of Intravenous Immunoglobulin in the Treatment of Twelve Youths with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections.

    PubMed

    Kovacevic, Miro; Grant, Paul; Swedo, Susan E

    2015-02-01

    This is a case series describing 12 youths treated with intravenous immunoglobulin (IVIG) for pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS). Although it is a clinically based series, the case reports provide new information about the short-term benefits of IVIG therapy, and are the first descriptions of long-term outcome for PANDAS patients. PMID:25658609

  9. Single dose intravenous methyl prednisolone versus oral prednisolone in Bell's palsy: A randomized controlled trial

    PubMed Central

    Giri, Prithvi; Garg, Ravindra Kumar; Singh, Maneesh Kumar; Verma, Rajesh; Malhotra, Hardeep Singh; Sharma, Praveen Kumar

    2015-01-01

    Objectives: Corticosteroids have been used in the treatment of Bell's palsy and several other postinfectious neurological conditions. We hypothesized that administration of a single dose of intravenous (IV) methylprednisolone might be an effective alternative to oral prednisolone. Materials and Methods: In this open label, randomized trial, patients with acute Bell's palsy were randomized into two groups. One group received single dose (500 mg) of IV methylprednisolone while the other group received 10 days of oral prednisone. Outcome was assessed at 1 and 3 months with House–Brackmann scale. Results: At 3 months, 93 (79.48%) patients had completely recovered. IV methylprednisolone and oral prednisolone groups had similar recovery rates (80% vs. 78.33%, P > 0.05). Patients with Grade 2 and 3 recovered completely. In patients with Grade 6, the recovery rate was 20%. A better outcome was observed if corticosteroids were administered within 3 days of onset of palsy. Conclusion: Intravenous methylprednisolone and oral prednisolone showed equivalent benefit in patients with acute Bell's palsy. PMID:25878371

  10. Inappropriate Use of Intravenous PPI for Stress Ulcer Prophylaxis in an Inner City Community Hospital

    PubMed Central

    Perwaiz, Muhammad K.; Posner, Gerald; Hammoudeh, Fadi; Schmidt, Frances; Neupane, Narayan; Enriquez, Danilo; Gulati, Neerja

    2010-01-01

    Background Proton pump inhibitors (PPIs) are used for the treatment and prophylaxis of variety of acid peptic conditions including stress ulcers. There has been a persistent practice of their inappropriate use for stress ulcer prophylaxis. Purpose of our study was to measure the inappropriate use of Intravenous Proton Pump Inhibitors for stress ulcer prophylaxis and to estimate the financial burden. Methods We carried out a retrospective, analytic study from July 2008 to June 2009 in internal medicine department. Hospital pharmacy records were used to identify all patients who received IV PPI during hospital stay. Seventy-five percent of records were randomly chosen (n=1104). PPI application was defined as indicated according to AGA guidelines. Results Intravenous proton pump inhibitor (IV PPI) was prescribed for 68.5% of patients without any proper indication. The estimated cost of medication for inappropriate IV PPIS use during the study year was 18337 USD. Conclusions A more rational use of PPI will have better impact on health care cost and is likely to add to patient safety. Keywords Inappropriate use of PPI; Stress ulcer prophylaxis; Healthcare cost PMID:21629543

  11. Gold nanoparticles enhance the radiation therapy of a murine squamous cell carcinoma

    NASA Astrophysics Data System (ADS)

    Hainfeld, James F.; Avraham Dilmanian, F.; Zhong, Zhong; Slatkin, Daniel N.; Kalef-Ezra, John A.; Smilowitz, Henry M.

    2010-06-01

    The purpose of this study is to test the hypothesis that gold nanoparticle (AuNP, nanogold)-enhanced radiation therapy (nanogold radiation therapy, NRT) is efficacious when treating the radiation resistant and highly aggressive mouse head and neck squamous cell carcinoma model, SCCVII, and to identify parameters influencing the efficacy of NRT. Subcutaneous (sc) SCCVII leg tumors in mice were irradiated with x-rays at the Brookhaven National Laboratory (BNL) National Synchrotron Light Source (NSLS) with and without prior intravenous (iv) administration of AuNPs. Variables studied included radiation dose, beam energy, temporal fractionation and hyperthermia. AuNP-mediated NRT was shown to be effective for the sc SCCVII model. AuNPs were more effective at 42 Gy than at 30 Gy (both at 68 keV median beam energy) compared to controls without gold. Similarly, at 157 keV median beam energy, 50.6 Gy NRT was more effective than 44 Gy NRT. At the same radiation dose (~42 Gy), 68 keV was more effective than 157 keV. Hyperthermia and radiation therapy (RT) were synergistic and AuNPs enhanced this synergy, thereby further reducing TCD50 s (tumor control dose 50%) and increasing long-term survivals. It is concluded that gold nanoparticles enhance the radiation therapy of a radioresistant mouse squamous cell carcinoma. The data show that radiation dose, energy and hyperthermia influence efficacy and better define the potential utility of gold nanoparticles for cancer x-ray therapy.

  12. Suboptimal use of intravenous contrast during radiotherapy planning in the UK.

    PubMed

    Kim, S; Russell, W; Price, P; Saleem, A

    2008-12-01

    We aimed to evaluate the use of intravenous (IV) contrast during acquisition of radiotherapy planning (RTP) scans and to compare current usage with the Royal College of Radiologists' (RCR) recommendations. Questionnaires were circulated via the Academic Clinical Oncology and Radiobiology Research Network (ACORRN) website, email and post to 60 UK radiotherapy centre managers. Questions were asked regarding the (i) tumour sites where IV contrast was used, (ii) person administering the contrast, (iii) availability of dynamic pump, (iv) tumour sites that centres wished to use contrast, (v) reasons for not using contrast and (vi) awareness of RCR recommendations. 50 (83%) centres responded to the questionnaire, of which 27 responded via the ACCORN website and 18 by e-mail. Despite 38 out of 50 responding centres using IV contrast, and accessibility to dynamic pumps existing in 39 centres, IV contrast usage was suboptimal, with more than half of the centres (27/50; 54%) wishing to use it at more tumour sites. IV contrast was most often used during RTP of the brain, with suboptimal usage in lung tumours. None of the 50 centres administered IV contrast during RTP scan acquisition in all of the 8 RCR recommended tumour sites. Radiographers were mainly responsible for contrast administration, and a lack of staff was cited as the main reason for suboptimal contrast usage. Disappointingly, only 35 of the 50 radiotherapy managers (70%) were aware of the RCR recommendations. Redress of the underlying reasons for suboptimal IV contrast administration during RTP, including acquisition of the necessary skill mix by staff and implementation of RCR recommendations, would help standardize UK practice. PMID:18762482

  13. Inactivated simian immunodeficiency virus vaccine failed to protect rhesus macaques from intravenous or genital mucosal infection but delayed disease in intravenously exposed animals

    SciTech Connect

    Sutjipto, S.; Pedersen, N.C.; Miller, C.J.; Gardner, M.B.; Hanson, C.V.; Gettie, A.; Jennings, M.; Higgins, J.; Marx, P.A. (Univ. of California, Davis (USA))

    1990-05-01

    Eight rhesus macaques were immunized four times over a period of 8 months with a psoralen-UV-light-inactivated whole simian immunodeficiency virus vaccine adjuvanted with threonyl muramyl dipeptide. Eight unvaccinated control animals received adjuvant alone. Only the vaccinated animals made antibodies before challenge exposure to the viral core and envelope as determined by Western blotting (immunoblotting) and virus-neutralizing antibodies. Ten days after the final immunization, one-half of the vaccinated and nonvaccinated monkeys were challenged exposed intravenously (i.v.) and one-half were challenge exposed via the genital mucosa with virulent simian immunodeficiency virus. All of the nonvaccinated control monkeys became persistently infected. In spite of preexisting neutralizing antibodies and an anamnestic antibody response, all of the immunized monkeys also became persistently infected. However, there was evidence that the clinical course in immunized i.v. infected animals was delayed. All four mock-vaccinated i.v. challenge-exposed animals died with disease from 3 to 9 months postchallenge. In contrast, only one of four vaccinated i.v. challenge-exposed monkeys had died by 11 months postchallenge.

  14. Intravenous injection of AAVrh10-GALC after the neonatal period in twitcher mice results in significant expression in the central and peripheral nervous systems and improvement of clinical features.

    PubMed

    Rafi, Mohammad A; Rao, Han Zhi; Luzi, Paola; Luddi, Alice; Curtis, Mark T; Wenger, David A

    2015-03-01

    Globoid cell leukodystrophy (GLD) or Krabbe disease is an autosomal recessive disorder resulting from the defective lysosomal enzyme galactocerebrosidase (GALC). The lack of GALC enzyme leads to severe neurological symptoms. While most human patients are infants who do not survive beyond 2years of age, older patients are also diagnosed. In addition to human patients, several naturally occurring animal models, including dog, mouse, and monkey, have also been identified. The mouse model of Krabbe disease, twitcher (twi) mouse has been used for many treatment trials including gene therapy. Using the combination of intracerebroventricular, intracerebellar, and intravenous (iv) injection of the adeno-associated virus serotype rh10 (AAVrh10) expressing mouse GALC in neonate twi mice we previously have demonstrated a significantly extended normal life and exhibition of normal behavior in treated mice. In spite of the prolonged healthy life of these treated mice and improved myelination, it is unlikely that using multiple injection sites for viral administration will be approved for treatment of human patients. In this study, we have explored the outcome of the single iv injection of viral vector at post-natal day 10 (PND10). This has resulted in increased GALC activity in the central nervous system (CNS) and high GALC activity in the peripheral nervous system (PNS). As we have shown previously, an iv injection of AAVrh10 at PND2 results in a small extension of life beyond the typical lifespan of the untreated twi mice (~40days). In this study, we report that mice receiving a single iv injection at PND10 had no tremor and continued to gain weight until a few weeks before they died. On average, they lived 20-25days longer than untreated mice. We anticipate that this strategy in combination with other therapeutic options may be beneficial and applicable to treatment of human patients. PMID:25533112

  15. Routine resite of peripheral intravenous devices every 3 days did not reduce complications compared with clinically indicated resite: a randomised controlled trial

    Microsoft Academic Search

    Claire M Rickard; Damhnat McCann; Jane Munnings; Matthew R McGrail

    2010-01-01

    BACKGROUND: Peripheral intravenous device (IVD) complications were traditionally thought to be reduced by limiting dwell time. Current recommendations are to resite IVDs by 96 hours with the exception of children and patients with poor veins. Recent evidence suggests routine resite is unnecessary, at least if devices are inserted by a specialised IV team. The aim of this study was to

  16. Transmucosal fentanyl vs intravenous morphine in doses proportional to basal opioid regimen for episodic-breakthrough pain

    PubMed Central

    Mercadante, S; Villari, P; Ferrera, P; Casuccio, A; Mangione, S; Intravaia, G

    2007-01-01

    The use of supplemental doses of opioids is commonly suggested to manage breakthrough pain. A comparative study of intravenous morphine (IV-MO) and oral transmucosal fentanyl citrate (OTFC) given in doses proportional to the basal opioid regimen was performed in 25 cancer patients receiving stable opioid doses. For each episode, when it occurred and 15 and 30?min after the treatment, pain intensity and opioid-related symptoms were recorded. Fifty-three couples of breakthrough events, each treated with IV-MO and OTFC, were recorded. In episodes treated with IV-MO, pain intensity decreased from a mean of 6.9 to 3.3 and to 1.7 at T1 and T2, respectively. In episodes treated with OTFC, pain intensity decreased from a mean of 6.9 to 4.1 and to 2.4 at T1 and T2, respectively. Statistical differences between the two treatments were found at T1 (P=0.013), but not at T2 (P=0.059). Adverse effects were comparable and were not significantly related with the IV-MO and OTFC doses. Intravenous morphine and OTFC in doses proportional to the scheduled daily dose of opioids were both safe and effective, IV-MO having a shorter onset than OTFC. Future comparative studies with appropriate design should compare titration methods and proportional methods of OTFC dosing. PMID:17519902

  17. Clinical and Vascular Outcome in Internal Carotid Artery Versus Middle Cerebral Artery Occlusions After Intravenous Tissue Plasminogen Activator

    Microsoft Academic Search

    Italo Linfante; Rafael H. Llinas; Magdy Selim; Claudia Chaves; Sandeep Kumar; Robert A. Parker; Louis R. Caplan; Gottfried Schlaug

    2010-01-01

    Background and Purpose—Early reperfusion is a predictor of good outcome in acute ischemic stroke. We investigated whether middle cerebral artery (MCA) occlusions have a better clinical outcome and proportion of recanalization compared with internal carotid artery (ICA) occlusion after standard treatment with intravenous (IV) tissue plasminogen activator (tPA). Patients—In a retrospective analysis of our prospective stroke database between January 7,

  18. Anemia management: development of a rapidaccess anemia and intravenous iron service

    PubMed Central

    Radia, Deepti; Momoh, Ibrahim; Dillon, Richard; Francis, Yvonne; Cameron, Laura; Fagg, Toni-Lee; Overland, Hannah; Robinson, Susan; Harrison, Claire N

    2013-01-01

    This article describes the initiation and evolution of the Rapid-Access Anemia Clinic (RAAC) at Guy’s and St Thomas’ Hospitals, London, UK. This clinic was set up to provide diagnosis and treatment, and to coordinate investigative procedures, where necessary, into the underlying causes of anemia. Initially piloted with anemic preoperative orthopedic patients, the clinic now treats a wide range of conditions, deriving from both internal and external referrals. Treatment includes dietary advice, supplementation with iron, vitamin B12 and folate, and blood transfusion. Most patients at the RAAC need iron replacement, the majority of which require intravenous (IV) iron. Therefore the first-line IV iron-administration protocol is carefully considered to ensure viability of the service and patient satisfaction. Four IV irons available in the UK are discussed, with explanation of the benefits and drawbacks of each product and the reasoning behind the IV iron choice at different stages of the RAAC’s development. Costs to the service, affected by IV iron price and administration regimen, are considered, as well as the product’s contraindications. Finally, the authors reflect on the success of the RAAC and how it has improved patients’ quality-of-treatment experience, in addition to benefiting the hospital and National Health Service in achieving specific health-care mandates and directives. Drawing from the authors’ experiences, recommendations are given to assist others in setting up and providing a successful rapid-access anemia service or similar facility. PMID:23950666

  19. Anemia management: development of a rapidaccess anemia and intravenous iron service.

    PubMed

    Radia, Deepti; Momoh, Ibrahim; Dillon, Richard; Francis, Yvonne; Cameron, Laura; Fagg, Toni-Lee; Overland, Hannah; Robinson, Susan; Harrison, Claire N

    2013-01-01

    This article describes the initiation and evolution of the Rapid-Access Anemia Clinic (RAAC) at Guy's and St Thomas' Hospitals, London, UK. This clinic was set up to provide diagnosis and treatment, and to coordinate investigative procedures, where necessary, into the underlying causes of anemia. Initially piloted with anemic preoperative orthopedic patients, the clinic now treats a wide range of conditions, deriving from both internal and external referrals. Treatment includes dietary advice, supplementation with iron, vitamin B12 and folate, and blood transfusion. Most patients at the RAAC need iron replacement, the majority of which require intravenous (IV) iron. Therefore the first-line IV iron-administration protocol is carefully considered to ensure viability of the service and patient satisfaction. Four IV irons available in the UK are discussed, with explanation of the benefits and drawbacks of each product and the reasoning behind the IV iron choice at different stages of the RAAC's development. Costs to the service, affected by IV iron price and administration regimen, are considered, as well as the product's contraindications. Finally, the authors reflect on the success of the RAAC and how it has improved patients' quality-of-treatment experience, in addition to benefiting the hospital and National Health Service in achieving specific health-care mandates and directives. Drawing from the authors' experiences, recommendations are given to assist others in setting up and providing a successful rapid-access anemia service or similar facility. PMID:23950666

  20. Intravenous human rabies immunoglobulin for post-exposure prophylaxis: serum rabies neutralizing antibody concentrations and side-effects.

    PubMed

    Aoki, F Y; Rubin, M E; Friesen, A D; Bowman, J M; Saunders, J R

    1989-01-01

    The beneficial effect of passive immunization for post-exposure rabies prophylaxis is associated with the appearance of serum neutralizing antibody (SNA) earlier than occurs with vaccine alone. We compared the SNA response and the side-effects in 30 previously unimmunized healthy volunteers given a commercially available human rabies immunoglobulin (HRIG) intramuscularly (i.m.) or an experimental HRIG prepared by DEAE Sephadex column chromatography, intravenously (i.v.) with or without human diploid-cell culture rabies vaccine (HDCS). The subjects were divided into five equal groups: HDCS alone, HDCS + i.m. HRIG 20 IU/kg (currently recommended), i.v. HRIG alone 15 IU/kg, HDCS + i.v. HRIG 15 IU/kg or HDCS + HRIG 5 IU/kg i.v. plus 10 IU/kg i.m. to simulate local bite wound infiltration. HDCS, 1.0 ml, was injected subcutaneously (s.c.) on days 0, 3, 7, 14 and 28. Only local discomfort at injection sites was observed without differences between groups. SNA was demonstrated in all HRIG recipients at day 1, but the concentrations were higher in those receiving it intravenously. No difference in the SNA response to vaccine was observed between the i.v. and i.m. HRIG groups given the same vaccine lot. It would appear that i.v. HRIG 15 IU/kg can be substituted for i.m. HRIG 20 IU/kg for post-exposure prophylaxis. Since the current regimen is almost 100% protective, there is no way of proving that i.v. HRIG 15 IU/kg is more efficacious. The immediate SNA level and economy are the chief advantages of i.v. HRIG 15 IU/kg. PMID:2646301

  1. Intravenous ascorbic acid as an adjuvant to interleukin-2 immunotherapy

    PubMed Central

    2014-01-01

    Interleukin-2 (IL-2) therapy has been demonstrated to induce responses in 10-20% of advanced melanoma and renal cell carcinoma patients, which translates into durable remissions in up to half of the responsers. Unfortunately the use of IL-2 has been associated with severe toxicity and death. It has been previously observed and reported that IL-2 therapy causes a major drop in circulating levels of ascorbic acid (AA). The IL-2 induced toxicity shares many features with sepsis such as capillary leakage, systemic complement activation, and a relatively non-specific rise in inflammatory mediators such as TNF-alpha, C-reactive protein, and in advanced cases organ failure. Animal models and clinical studies have shown rapid depletion of AA in conditions of sepsis and amelioration associated with administration of AA (JTM 9:1-7, 2011). In contrast to other approaches to dealing with IL-2 toxicity, which may also interfere with therapeutic effects, AA possesses the added advantage of having direct antitumor activity through cytotoxic mechanisms and suppression of angiogenesis. Here we present a scientific rationale to support the assessment of intravenous AA as an adjuvant to decrease IL-2 mediated toxicity and possibly increase treatment efficacy. PMID:24884532

  2. Intelligent Virtual Station (IVS)

    NASA Technical Reports Server (NTRS)

    2002-01-01

    The Intelligent Virtual Station (IVS) is enabling the integration of design, training, and operations capabilities into an intelligent virtual station for the International Space Station (ISS). A viewgraph of the IVS Remote Server is presented.

  3. Uterine balloon therapy to treat menorrhagia

    Microsoft Academic Search

    K Buckshee; K Banerjee; H Bhatla

    1998-01-01

    Objective: To study the clinical efficacy, safety and acceptability of the thermal balloon endometrial ablation (TBEA) in patients with dysfunctional uterine bleeding. Methods: Thirteen patients with DUB who did not respond to medical treatment and dilatation and curettage consented to a trial of TBEA with EASYTM model of balloon catheter by Gynecare. All procedures were done under intravenous (IV) sedation

  4. Association of Socioeconomic Status with the Use of Chronic Therapies and Healthcare Utilization in Children with Cystic Fibrosis

    PubMed Central

    Schechter, Michael S.; McColley, Susanna A.; Silva, Stefanie; Haselkorn, Tmirah; Konstan, Michael W.; Wagener, Jeffrey S.

    2014-01-01

    Objective To determine whether previously reported socioeconomic status (SES)-related disparities in cystic fibrosis (CF) health outcomes vary by the indicator used (median household income by zip code [MIZ], maternal educational attainment [MEA], and state insurance coverage [MA]), and whether these disparities can be explained by differences in medical treatment. Study design A cross-sectional analysis of data on patients age <18 years from the Epidemiologic Study of Cystic Fibrosis (ESCF). Results Disease severity showed a similar inverse correlation with all 3 SES measures. The number of stable clinic visits was unrelated to SES. Patients with MA had more sick outpatient visits and more courses of intravenous (IV) antibiotics for pulmonary exacerbations, and were more likely to be prescribed all chronic therapies. Low-MIZ patients had slightly fewer sick visits and more courses of IV antibiotics, and were more likely to receive oral nutrition supplements but less likely to receive macrolide prescriptions. Low-MEA patients were less likely to receive IV antibiotics at home, more likely to receive oral nutrition supplements, but less likely to receive macrolide prescriptions. Conclusions CF health outcomes are correlated with the SES spectrum, but these disparities are not explained by differential use of health services or prescription of chronic therapy. Future investigations should focus on the possible impact of environmental exposures and differences in disease self-management. PMID:19608199

  5. Thrombolytic therapy in acute ischemic stroke

    Microsoft Academic Search

    Anthony J. Furlan; Irene L. Katzan; Louis R. Caplan

    2003-01-01

    Opinion statement  The use of intravenous thrombolytic therapy for the treatment of patients with acute ischemic stroke is now approved in the\\u000a United States, Canada, Germany, and the European Union. Guidelines published in 1996 from the American Heart Association and\\u000a American Academy of Neurology committees recommended intravenous administration of recombinant tissue-plasminogen activator\\u000a (rt-PA) (0.9 mg\\/kg; maximum of 90 mg) given in

  6. Visualization of Coronary Arteries from Intravenous Angiograms

    NASA Technical Reports Server (NTRS)

    Selzer, Robert H.

    1985-01-01

    Under most circumstances, the coronary arteries are not satisfactorily visualized in intravenous angiograms. The objective of this study is to develop computer image enhancement methods that will improve the quality of the latent coronary images to a degree sufficient to detect an obstructive lesion. Such a technique, if successful, could be used as a first step alternative to conventional coronary angiography for individuals with ambiguous noninvasive cardiac tests. The determination of no lesion from the intravenous procedure would relieve the need for the conventional angiogram, while verification of an obstructive lesion could be followed by a conventional angiogram. The nature of the imaging problem and a description of the methods and initial processing results are described in this paper.

  7. Surgical treatment of infective endocarditis in active intravenous drug users: a justified procedure?

    PubMed Central

    2014-01-01

    Background Infective endocarditis is a life threatening complication of intravenous drug abuse, which continues to be a major burden with inadequately characterised long-term outcomes. We reviewed our institutional experience of surgical treatment of infective endocarditis in active intravenous drug abusers with the aim of identifying the determinants long-term outcome of this distinct subgroup of infective endocarditis patients. Methods A total of 451 patients underwent surgery for infective endocarditis between January 1993 and July 2013 at the University Hospital of Heidelberg. Of these patients, 20 (7 female, mean age 35?±?7.7 years) underwent surgery for infective endocarditis with a history of active intravenous drug abuse. Mean follow-up was 2504?±?1842 days. Results Staphylococcus aureus was the most common pathogen detected in preoperative blood cultures. Two patients (10%) died before postoperative day 30. Survival at 1, 5 and 10 years was 90%, 85% and 85%, respectively. Freedom from reoperation was 100%. Higher NYHA functional class, higher EuroSCORE II, HIV infection, longer operating time, postoperative fever and higher requirement for red blood cell transfusion were associated with 90-day mortality. Conclusions In active intravenous drug abusers, surgical treatment for infective endocarditis should be performed as extensively as possible and be followed by an aggressive postoperative antibiotic therapy to avoid high mortality. Early surgical intervention is advisable in patients with precipitous cardiac deterioration and under conditions of staphylococcal endocarditis. However, larger studies are necessary to confirm our preliminary results. PMID:24661344

  8. [Intravenous subtraction angiography (ISA). Technique and application (author's transl)].

    PubMed

    Friedrich, M; Sörensen, R

    1982-06-01

    Indirect arteriography of the abdominal aorta was performed in 171 patients by means of an intravenous bolus injection followed by conventional photographic image subtraction; the renal arteries were shown in 125 patients, the aortic arch and neck vessels in 20, peripheral vascular occlusions after percutaneous transluminal angioplasty in 17 and A-V shunts in dialysis patients in seven. The technique of injection, radiography and subtraction is described and the required dose compared with that for renal angiotomography. Provided the patient is adequately prepared, both renal arteries can be adequately demonstrated by ISA in 90% of patients. Using high-intensification screens, renal ISA requires less than half the dose necessary for angiotomography with a tomographic box and is suitable as a valuable screening method in conjunction with excretion urography. In the extremities, ISA produced adequate demonstration of stenoses, the vessel wall and collaterals. ISA of A-V shunts in haemodialysis patients is to be preferred to peripheral I-V xero-arteriography. PMID:6213501

  9. Evaluation of antiemetic effect of intravenous palonosetron versus intravenous ondansetron in laparoscopic cholecystectomy: A randomized controlled trial

    PubMed Central

    Laha, Baisakhi; Hazra, Avijit; Mallick, S.

    2013-01-01

    Objectives: Incidence of postoperative nausea and vomiting (PONV), without active intervention, following laparoscopic cholecystectomy is unacceptably high. We evaluated the effectiveness of intravenous (IV) palonosetron in counteracting PONV during the first 24hrs following laparoscopic cholecystectomy, using ondansetron as the comparator drug. Materials and Methods: In a randomized, controlled, single blind, parallel group trial, single pre-induction IV doses of palonosetron (75mcg) or ondansetron (4mg) were administered to adult patients of either sex undergoing elective laparoscopic cholecystectomy. There were 49 subjects per group. The pre-anesthetic regimen, anesthesia procedure and laparoscopic technique were uniform. The primary effectiveness measure was total number of PONV episodes in the 24 hrs period following end of surgery. The frequencies of individual nausea, retching and vomiting episodes, visual analog scale (VAS) score for nausea at 2, 6 and 24hrs, use of rescue antiemetic (metoclopramide), number of complete responders (no PONV or use of rescue in 24 hrs) and adverse events were secondary measures. Results: There was no statistically significant difference between the groups in primary outcome. Similarly, the frequencies of nausea, retching and vomiting episodes, when considered individually, did not show significant difference. Nausea score was comparable at all time points. With palonosetron, 14 subjects (28.6%) required rescue medication while 13 (26.5%) did so with ondansetron. The number of complete responders was 14 (28.6%) and 16 (32.7%), respectively. Adverse events were few and mild. QTc prolongation was not encountered. Conclusion: Palonosetron is comparable to ondansetron for PONV prophylaxis in elective laparoscopic cholecystectomy when administered as single pre-induction dose. PMID:23543732

  10. A comparison between intravenous iron polymaltose complex (Ferrum Hausmann) and oral ferrous fumarate in the treatment of iron deficiency anaemia in pregnancy.

    PubMed

    Singh, K; Fong, Y F; Kuperan, P

    1998-02-01

    Anaemia is the most common medical disorder in pregnancy with iron deficiency anaemia accounting for the majority of cases. Over 90% of the iron deficiency anaemia is due to red cell iron deficiency associated with depleted iron stores and deficient intake. The two main modalities of treating iron deficiency anaemia are oral or parenteral iron. Ferrous Hausmann (iron dextrin) is the latest iron preparation which can be used for intravenous parenteral administration as a total dose infusion. This study compares the efficacy of Ferrum Hausmann with oral ferrous fumarate therapy in the treatment of iron deficiency anaemia in pregnancy. Our study shows that treatment with intravenous Ferrum Hausmann (iron dextrin) resulted in a significantly better level and rate of increase of haemoglobin (p<0.001). Serum ferritin, which is the best indicator of iron stores, was significantly higher (p<0.001) in the intravenous group. Other indices of iron status such as serum iron, serum transferrin and zinc protoporphyrin also showed a significant improvement in the intravenous group compared to those given oral iron. The results suggest that intravenous iron as a total dose infusion is able to replenish iron stores more efficiently, completely and at a faster rate than oral iron therapy, thus providing the fuel for stimulation of full erythopoiesis compared to oral iron. There were also no reports of any adverse reactions with intravenous iron dextrin, whereas there were a considerable proportion of women on oral iron therapy who reported side effects. In conclusion, intravenous iron therapy with Ferrous Hausmann (iron dextrin) is a suitable, effective and safe alternative to oral iron therapy in the treatment of iron deficiency anaemia in pregnancy. PMID:9508353

  11. Pharmacokinetics of intravenous and subcutaneous cefovecin in alpacas.

    PubMed

    Cox, S; Sommardahl, C; Seddighi, R; Videla, R; Hayes, J; Pistole, N; Hamill, M; Doherty, T

    2014-11-19

    The purpose of this study was to determine the pharmacokinetics of cefovecin after intravenous and subcutaneous dose of 8 mg/kg to alpacas. Bacterial infections requiring long-term antibiotic therapy such as neonatal bacteremia, pneumonia, peritonitis, dental, and uterine infections are a significant cause of morbidity and mortality in this species. However, few antimicrobials have been evaluated and proven to have favorable pharmacokinetics for therapeutic use. Most antimicrobials that are currently used require daily injections for many days. Cefovecin is a long-acting cephalosporin that is formulated for subcutaneous administration, and its long-elimination half-life allows for 14-day dosing intervals in dogs and cats. The properties of cefovecin may be advantageous for medical treatment of camelids due to its broad spectrum, route of administration, and long duration of activity. Pharmacokinetic evaluation of antimicrobial drugs in camelids is essential for the proper treatment and prevention of bacterial disease, and to minimize development of antibiotic resistant bacterial strains due to inadequate antibiotic concentrations. Cefovecin mean half-life, volume of distribution at steady-state, and clearance after intravenous administration were 10.3 h, 86 mL/kg, and 7.07 mL·h/kg. The bioavailability was 143%, while half-life, Cmax , and Tmax were 16.9 h, 108 ?g/mL, and 2.8 h following subcutaneous administration. In the absence of additional microbial susceptibility data for alpaca pathogens, the current cefovecin dosage regimen prescribed for dogs (8 mg/kg SC every 14 days) may need to be optimized for the treatment of infections in this species. PMID:25407784

  12. Contrast agent choice for intravenous coronary angiography

    SciTech Connect

    Zeman, H.D.; Siddons, D.P.

    1989-01-01

    The screening of the general population for coronary artery disease would be practical if a method existed for visualizing the extent of occlusion after an intravenous injection of contrast agent. Measurements performed with monochromatic synchrotron radiation x-rays and an iodine containing contrast agent at the Stanford Synchrotron Radiation Laboratory have shown that such an intravenous angiography procedure would be possible with an adequately intense monochromatic x-ray source. Because of the size and cost of synchrotron radiation facilities it would be desirable to make the most efficient use of the intensity available, while reducing as much as possible the radiation dose experienced by the patient. By choosing contrast agents containing elements with a higher atomic number than iodine, it is possible to both improve the image quality and reduce the patient radiation dose, while using the same synchrotron source. By using Si monochromator crystals with a small mosaic spread, it is possible to increase the x-ray flux available for imaging by over an order of magnitude, without any changes in the storage ring or wiggler magnet. The most critical imaging task for intravenous coronary angiography utilizing synchrotron radiation x-rays is visualizing a coronary artery through the left ventricle or aorta which also contains a contrast agent. Calculations have been made of the signal to noise ratio expected for this imaging task for various contrast agents with atomic numbers between that of iodine and bismuth.

  13. Intravenous Lipids for Preterm Infants: A Review

    PubMed Central

    Salama, Ghassan SA; Kaabneh, Mahmmoud AF; Almasaeed, Mai N; Alquran, Mohammad IA

    2015-01-01

    Extremely low birth weight infants (ELBW) are born at a time when the fetus is undergoing rapid intrauterine brain and body growth. Continuation of this growth in the first several weeks postnatally during the time these infants are on ventilator support and receiving critical care is often a challenge. These infants are usually highly stressed and at risk for catabolism. Parenteral nutrition is needed in these infants because most cannot meet the majority of their nutritional needs using the enteral route. Despite adoption of a more aggressive approach with amino acid infusions, there still appears to be a reluctance to use early intravenous lipids. This is based on several dogmas that suggest that lipid infusions may be associated with the development or exacerbation of lung disease, displace bilirubin from albumin, exacerbate sepsis, and cause CNS injury and thrombocytopena. Several recent reviews have focused on intravenous nutrition for premature neonate, but very little exists that provides a comprehensive review of intravenous lipid for very low birth and other critically ill neonates. Here, we would like to provide a brief basic overview, of lipid biochemistry and metabolism of lipids, especially as they pertain to the preterm infant, discuss the origin of some of the current clinical practices, and provide a review of the literature, that can be used as a basis for revising clinical care, and provide some clarity in this controversial area, where clinical care is often based more on tradition and dogma than science. PMID:25698888

  14. Primary Pulmonary Hypertension: Improved Long-Term Effects and Survival With Continuous Intravenous Epoprostenol Infusion

    Microsoft Academic Search

    Shelley M Shapiro; Ronald J Oudiz; Tiesheng Cao; Matthew A Romano; X. Joy Beckmann; Demitrios Georgiou; Sarathy Mandayam; Leonard E Ginzton; Bruce H Brundage

    1997-01-01

    Objectives. This study sought to determine the long-term effects of continuous infusion of epoprostenol (epo) therapy on survival and pulmonary artery pressure in patients with primary pulmonary hypertension (PPH).Background. PPH is a progressive disease for which there are few effective therapies.Methods. Patients with PPH and New York Heart Association functional class III or IV symptoms of congestive heart failure underwent

  15. Serum levels of hematoporphyrin derivatives in the photodynamic therapy of malignant tumors

    NASA Astrophysics Data System (ADS)

    Chan, H. K.; Low, K. S.; Haji Baba, A. S.; Arimbalam, S.; Yip, C. H.; Chang, K. W.; Baskaran, G.; Lo, Y. L.; Jayalakshmi, P.; Looi, L. M.; Tan, N. H.

    1995-03-01

    In photodynamic therapy (PDT), red light is administered 24 - 72 hours post intravenous (i.v.) injection of hematoporphyrin derivatives (HpD). In an earlier animal model study, more effective therapeutic response was obtained when red light irradiation was carried out 15 mins after the injection of HpD. The effectiveness of this immediate PDT protocol has been correlated to the high serum level of HpD immediately after administration and the destruction of the microcirculation system as the dominant tumor destruction mechanism. This study examines the pharmacokinetics and the serum levels of HpD in rats and also in human patients. Such data can assist in defining the optimum time delay for light irradiation in the PDT of cancer.

  16. Phase 1 dose-escalation study of IV ixazomib, an investigational proteasome inhibitor, in patients with relapsed/refractory lymphoma

    PubMed Central

    Assouline, S E; Chang, J; Cheson, B D; Rifkin, R; Hamburg, S; Reyes, R; Hui, A-M; Yu, J; Gupta, N; Di Bacco, A; Shou, Y; Martin, P

    2014-01-01

    Ixazomib is an investigational proteasome inhibitor that has shown preclinical activity in lymphoma models. This phase 1 study assessed the safety, tolerability, maximum tolerated dose (MTD), pharmacokinetics, pharmacodynamics and preliminary activity of intravenous (IV) ixazomib in relapsed/refractory lymphoma patients who had received ?2 prior therapies. Thirty patients with a range of histologies received ixazomib 0.125?3.11?mg/m2 on days 1, 8 and 15 of 28-day cycles. Patients received a median of two cycles (range 1?36). MTD was determined to be 2.34?mg/m2. Most common drug-related adverse events (AEs) included fatigue (43%), diarrhea (33%), nausea, vomiting and thrombocytopenia (each 27%). Drug-related grade ?3 AEs included neutropenia (20%), thrombocytopenia (13%) and diarrhea (10%). Drug-related peripheral neuropathy occurred in four (13%) patients; no grade ?3 events were reported. Plasma exposure increased dose proportionally from 0.5?3.11?mg/m2; terminal half-life was 4?12 days after multiple dosing. Of 26 evaluable patients, five achieved responses: 4/11 follicular lymphoma patients (one complete and three partial responses) and 1/4 peripheral T-cell lymphoma patients (partial response). Sustained responses were observed with ?32 cycles of treatment in two heavily pretreated follicular lymphoma patients. Results suggest weekly IV ixazomib is generally well tolerated and may be clinically active in relapsed/refractory lymphoma. PMID:25325301

  17. Comparing the Efficacy of Intravenous Acetaminophen and Intravenous Meperidine in Pain Relief After Outpatient Urological Surgery

    PubMed Central

    Kolahdouzan, Khosro; Eydi, Mahmood; Mohammadipour Anvari, Hassan; Golzari, Samad EJ; Abri, Reyhaneh; Ghojazadeh, Morteza; Ojaghihaghighi, Seyed Hossein

    2014-01-01

    Background: Pain relief after surgery is an essential component of postoperative care. Objectives: The purpose of this study was to compare the efficacy of intravenous acetaminophen and intravenous meperidine in pain relief after outpatient urological surgery. Patients and Methods: In a prospective, randomized, double-blind clinical trial, 100 outpatients of urological surgery were studied in two groups of acetaminophen (A) and meperidine (M). Patients in group A received 1g of acetaminophen in 100 mL saline within 15 minutes and patients in group M received a single intravenous injection of meperidine 0.5 mg/kg, 15 minutes prior to the end of operation. Postoperative pain was recorded using visual analog scale (VAS). Vital signs, nausea, vomiting, dizziness and respiratory depressions were compared between the two groups. Results: Pain severity in patients treated with intravenous acetaminophen six hours after the operation within one-hour interval was significantly lower than meperidine group (P < 0.0001). Ninety patients in the meperidine group and five patients in the acetaminophen group required additional doses of analgesics. Nausea was significantly lower in acetaminophen group than meperidine group. Conclusions: Intravenous acetaminophen reduced pain following outpatient urological surgery more significantly than meperidine. PMID:25798377

  18. FOLFIRI plus bevacizumab as a second-line therapy for metastatic intrahepatic cholangiocarcinoma

    PubMed Central

    Guion-Dusserre, Jean-Florian; Lorgis, Veronique; Vincent, Julie; Bengrine, Leila; Ghiringhelli, Francois

    2015-01-01

    AIM: To evaluate the efficacy and tolerance of FOLFIRI plus bevacizumab treatment outcome as second-line treatment for metastatic intrahepatic cholangiocarcinoma. METHODS: Thirteen consecutive patients with metastatic intrahepatic cholangiocarcinoma who were refractory to first-line therapy consisting of gemcitabine plus oxaliplatin-based first-line chemotherapy given intravenously via intra-arterial infusion were treated with FOLFIRI [irinotecan (180 mg/m² i.v. over 90 min) concurrently with folinic acid (400 mg/m² i.v. over 120 min) followed by fluorouracil (400 mg/m² i.v. bolus) then fluorouracil 2400 mg/m² intravenous infusion over 46 h] and bevacizumab (5 mg/kg) every 2 wk. Tumor response was evaluated by computed tomography scan every 4 cycles. RESULTS: The best tumor responses using response evaluation criteria in solid tumor criteria were: complete response for 1 patient, partial response for 4 patients, and stable disease for 6 patients after 6 mo of follow-up. The response rate was 38.4% (95%CI: 12.5-89) and the disease control rate was 84.5% (95%CI: 42-100). Seven deaths occurred at the time of analysis, progression free survival was 8 mo (95%CI: 7-16), and median overall survival was 20 mo (95%CI: 8-48). No grade 4 toxic events were observed. Four grade 3 hematological toxicities and one grade 3 digestive toxicity occurred. An adaptive reduction in chemotherapy dosage was required in 2 patients due to hematological toxicity, and a delay in chemotherapy cycles was required for 3 patients. CONCLUSION: FOLFIRI plus bevacizumab combination treatment showed promising efficacy and safety as second-line treatment for metastatic intrahepatic cholangiocarcinoma after failure of the first-line treatment of gemcitabine plus oxaliplatin chemotherapy. PMID:25717243

  19. Effect on postoperative analgesia of small-dose lysine acetylsalicylate added to prilocaine during intravenous regional anesthesia.

    PubMed

    Corpataux, J B; Van Gessel, E F; Donald, F A; Forster, A; Gamulin, Z

    1997-05-01

    Nonsteroidal antiinflammatory drugs act largely peripherally by blocking the local synthesis of prostaglandins. The aim of this study was to evaluate whether the addition of a small dose of lysine acetylsalicylate (LA) to the prilocaine used for intravenous regional anesthesia (IVRA) would improve the quality of postoperative analgesia. Sixty patients undergoing lower extremity IVRA for foot or ankle surgery were randomly assigned to three double-blind groups: LA-IVRA where 90 mg of LA was mixed with prilocaine 0.5% for IVRA and 1 mL of 0.9% NaCl administered intravenously (IV) through the forearm catheter after tourniquet inflation; LA-IV where 1 mL of 0.9% NaCl was mixed with prilocaine and 90 mg of LA administered IV; and placebo where 1 mL of 0.9% NaCl was administered both with prilocaine for the IVRA and IV. Duration of analgesia (time elapsed between tourniquet release and first injection of morphine, expressed as mean +/- SD) was significantly longer (P < 0.05) in LA-IVRA (387 +/- 216 min) when compared with LA-IV (175 +/- 264 min) and placebo (126 +/- 201 min). Analgesic requirements remained significantly lower in LA-IVRA when compared with placebo only during the first six postoperative hours, LA-IV being in an intermediate position. Pain scores were significantly lower in LA-IVRA during the first postoperative hour when compared with LA-IV and during the first 3 postoperative hours when compared with placebo. We conclude that 90 mg of LA (corresponding to 50 mg of acetylsalicylic acid) added to prilocaine 0.5% during IVRA improves the quality of postoperative analgesia in the early postoperative period. PMID:9141935

  20. A novel form of dichloroacetate therapy for patients with advanced cancer: a report of 3 cases.

    PubMed

    Khan, Akbar; Marier, Denis; Marsden, Eric; Andrews, Douglas; Eliaz, Isaac

    2014-10-01

    Oral dichloroacetate sodium (DCA) is currently under investigation as a single agent and as an adjuvant for treatment of various cancers. One of the factors limiting its clinical use in a continuous oral regimen is a dose-related, reversible neurotoxicity, including peripheral neuropathy and encephalopathy. The intravenous (IV) route has a number of potential advantages, including (1) pulsed dosing to achieve higher concentrations than feasible with oral use, (2) a longer washout period to reduce the potential for neurotoxicity, and (3) a bypassing of the digestive system, which is particularly significant for advanced-stage cancer patients. Data were available on high-dose IV DCA (up to 100 mg/kg/dose) that have confirmed its safety, both in healthy volunteers and in critically ill patients, allowing the authors to begin off-label treatment of cancer patients. In several of their patients treated with IV DCA, the authors observed clinical, hematological, or radiological responses. This article presents 3 cases with patients who had recurrent cancers and for whom all conventional therapies had failed: (1) a 79-y-old male patient with colon cancer who had liver metastases, (2) a 43-y-old male patient with angiosarcoma who had pancreatic and bone metastases, and (3) a 10-y-old male patient with pancreatic neuroendocrine carcinoma who had liver metastases. PMID:25362214

  1. Clinical manifestation and management of intravenous mercury injection: a case report.

    PubMed

    Kobidze, T; Urushadze, O; Afandiyev, I; Nemsadze, G; Loladze, D

    2014-01-01

    Intentional self-injection of metallic mercury case report is presented. A 22 year old man with a past medical history of ethylene glycol suicidal poisoning was admitted to a Acad. N. Kipshidze Central University Clinic in Tbilisi, four months after deliberate intravenous injection of an unknown quantity of metallic mercury from several thermometers into his antecubital vein. After 2 months of asymptomatic period, the patient began to complain of pain and tremor in limbs, fatigue and skin rash. CT scan of the thorax and the abdomen confirmed multiple small opacities of metallic density in both lungs, liver and right kidney. After the procedure the patient was transferred to the toxicology center in Baku, Azerbaijan for chelation therapy. On arrival no biochemical abnormalities in hepatic or renal function or clinical pulmonary malfunction were detected, despite presence of slight symptoms of erethism, tremor mercuralis, knee joints arthralgia and lower extremities weakness. Chelation therapy with intramuscular injection of Unithiol (DMPS) was started in dose of 20mg/kg/day. After one month of chelation therapy, mercury blood concentration slowly decreased from initially 134 microgram/L to 105 microgram/L. This case report demonstrates mild acute toxicity following intravenous administration of unknown amounts of elemental mercury. Because of chelation therapy can remove approximately 1 mg of mercury per day the patient was recommended further long-term DMPS treatments under the control blood mercury levels. It is concluded that clinical manifestations of intravenous elemental mercury intoxication may be delayed despite significant increase in blood mercury level. PMID:24523325

  2. FIND-CKD: a randomized trial of intravenous ferric carboxymaltose versus oral iron in patients with chronic kidney disease and iron deficiency anaemia

    PubMed Central

    Macdougall, Iain C.; Bock, Andreas H.; Carrera, Fernando; Eckardt, Kai-Uwe; Gaillard, Carlo; Van Wyck, David; Roubert, Bernard; Nolen, Jacqueline G.; Roger, Simon D.

    2014-01-01

    Background The optimal iron therapy regimen in patients with non-dialysis-dependent chronic kidney disease (CKD) is unknown. Methods Ferinject® assessment in patients with Iron deficiency anaemia and Non-Dialysis-dependent Chronic Kidney Disease (FIND-CKD) was a 56-week, open-label, multicentre, prospective and randomized study of 626 patients with non-dialysis-dependent CKD, anaemia and iron deficiency not receiving erythropoiesis-stimulating agents (ESAs). Patients were randomized (1:1:2) to intravenous (IV) ferric carboxymaltose (FCM), targeting a higher (400–600 µg/L) or lower (100–200 µg/L) ferritin or oral iron therapy. The primary end point was time to initiation of other anaemia management (ESA, other iron therapy or blood transfusion) or haemoglobin (Hb) trigger of two consecutive values <10 g/dL during Weeks 8–52. Results The primary end point occurred in 36 patients (23.5%), 49 patients (32.2%) and 98 patients (31.8%) in the high-ferritin FCM, low-ferritin FCM and oral iron groups, respectively [hazard ratio (HR): 0.65; 95% confidence interval (CI): 0.44–0.95; P = 0.026 for high-ferritin FCM versus oral iron]. The increase in Hb was greater with high-ferritin FCM versus oral iron (P = 0.014) and a greater proportion of patients achieved an Hb increase ?1 g/dL with high-ferritin FCM versus oral iron (HR: 2.04; 95% CI: 1.52–2.72; P < 0.001). Rates of adverse events and serious adverse events were similar in all groups. Conclusions Compared with oral iron, IV FCM targeting a ferritin of 400–600 µg/L quickly reached and maintained Hb level, and delayed and/or reduced the need for other anaemia management including ESAs. Within the limitations of this trial, no renal toxicity was observed, with no difference in cardiovascular or infectious events. ClinicalTrials.gov number NCT00994318. PMID:24891437

  3. Abuse liability of buprenorphine–naloxone tablets in untreated IV drug users

    Microsoft Academic Search

    Hannu Alho; David Sinclair; Erkki Vuori; Antti Holopainen

    2007-01-01

    Buprenorphine (Subutex®) is widely abused in Finland. A combination of buprenorphine plus naloxone (Suboxone®) has been available since late 2004, permitting a comparison of the abuse of the two products among untreated intravenous (IV) users. A survey was distributed to attendees at a Helsinki needle exchange program over 2-weeks in April, 2005, At least 30% were returned anonymously. Survey variables

  4. Antibiotic therapy of cholera*

    PubMed Central

    Lindenbaum, John; Greenough, William B.; Islam, M. R.

    1967-01-01

    Recent clinical trials having established the value of tetracycline as an adjunct to fluid and electrolyte replacement in cholera treatment, a controlled trial of antibiotic therapy was conducted in Dacca on 318 adults hospitalized for cholera. The effects of 4 antibiotics orally administered in varying dosage schedules were studied. Cholera therapy with tetracycline or chloramphenicol caused a highly significant reduction in the duration of diarrhoea and of positive culture, in stool volume, and in intravenous fluid requirement as compared with the results in controls who received intravenous fluid therapy only. Streptomycin was also effective, but to a lesser degree; paromomycin was of little value. The severity of dehydration on admission was significantly related to subsequent duration of diarrhoea regardless of whether antibiotics were given. Increasing age was associated with more prolonged purging in patients receiving antibiotics. Increasing the dose of tetracycline to 2 to 3 times that usually administered, or prolonging treatment from 2 to 4 days, did not enhance the therapeutic results. The effect of tetracycline was apparent within a few hours of administration. Bacteriological relapses were seen after discontinuation of therapy in all treatment groups, but were not due to the development of resistant bacteria. PMID:4865453

  5. Pharmacokinetics of enrofloxacin after intravenous and intramuscular administration in Angora goats.

    PubMed Central

    Elmas, M; Tras, B; Kaya, S; Bas, A L; Yazar, E; Yarsan, E

    2001-01-01

    Pharmacokinetics and bioavailability of enrofloxacin were determined after single intravenous (IV) and intramuscular (IM) administrations of 5 mg/kg body weight (BW) to 5 healthy adult Angora goats. Plasma enrofloxacin concentrations were measured by high performance liquid chromatography. Pharmacokinetics were best described by a 2-compartment open model. The elimination half-life and volume of distribution after IV and IM administrations were similar (t1/2beta, 4.0 to 4.7 h and Vd(ss),1.2 to 1.5 L/kg, respectively). Enrofloxacin was rapidly (t1/2a, 0.25 h) and almost completely absorbed (F, 90%) after IM administration. Mean plasma concentrations of enrofloxacin at 24 h after IV and IM administration (0.07 and 0.09 microg/mL, respectively) were higher than the minimal inhibitory concentration (MIC) values for most pathogens. In conclusion, once-daily IV and IM administration of enrofloxacin (5 mg/kg BW) in Angora goats may be useful in treatment of infectious diseases caused by sensitive pathogens. PMID:11227198

  6. Prolonged minor allograft survival in intravenously primed mice--a test of the veto hypothesis

    SciTech Connect

    Johnson, L.L.

    1987-07-01

    Experiments were performed to test the hypothesis that veto cells are responsible for the prolonged survival of minor allografts of skin that is observed in recipients primed intravenously with spleen cells from mice syngeneic with the skin donors. This prolonged survival was observed for each of several minor histocompatibility (H) antigens and is antigen-specific. Gamma radiation (3300 rads) abolished the ability of male spleen cells infused i.v. to delay the rejection of male skin grafts (H-Y antigen) on female recipients. However, depletion of Thy-1+ cells from the i.v. infusion failed to abolish the ability to prolong male skin graft survival. Furthermore, the prolonged survival accorded to B6 (H-2b) male skin grafts on CB6F1 (H-2b/H-2d) female recipients given i.v. infusions of B6 male spleen cells extended to BALB/c (H-2d) male skin grafts as well, indicating a lack of MHC restriction. Thus, prolongation of minor allograft survival by i.v. infusion of minor H antigen-bearing spleen cells appears not to depend on veto T cells that others have found to be responsible for the suppression of CTL generation.

  7. Pharmacokinetics of fluralaner in dogs following a single oral or intravenous administration

    PubMed Central

    2014-01-01

    Background Fluralaner is a novel systemic insecticide and acaricide. The purpose of these studies was to investigate the pharmacokinetic properties of fluralaner in Beagle dogs following single oral or intravenous (i.v.) administration. Methods Following the oral administration of 12.5, 25 or 50 mg fluralaner/kg body weight (BW), formulated as chewable tablets or i.v. administration of 12.5 mg fluralaner/kg BW, formulated as i.v. solution to 24 Beagles, plasma samples were collected until 112 days after treatment. Plasma concentrations of fluralaner were measured using HPLC-MS/MS. Pharmacokinetic parameters were calculated by non-compartmental methods. Results After oral administration, maximum plasma concentrations (Cmax) were reached within 1 day on average. Fluralaner was quantifiable in plasma for up to 112 days after single oral and i.v. treatment. The apparent half-life of fluralaner was 12–15 days and the mean residence time was 15–20 days. The apparent volume of distribution of fluralaner was 3.1 L/kg, and clearance was 0.14 L/kg/day. Conclusions Fluralaner is readily absorbed after single-dose oral administration, and has a long elimination half-life, long mean residence time, relatively high apparent volume of distribution, and low clearance. These pharmacokinetic characteristics help to explain the prolonged activity of fluralaner against fleas and ticks on dogs after a single oral dose. PMID:24606874

  8. Intravenous Flat-Detector Computed Tomography Angiography for Symptomatic Cerebral Vasospasm following Aneurysmal Subarachnoid Hemorrhage

    PubMed Central

    Jeon, Jin Pyeong; Sheen, Seung Hun; Cho, Yong-Jun

    2014-01-01

    The study evaluated the diagnostic accuracy of intravenous flat-detector computed tomography (IV FDCT) angiography in assessing hemodynamically significant cerebral vasospasm in patients with subarachnoid hemorrhage (SAH) with digital subtraction angiography (DSA) as the reference. DSA and IV FDCT were conducted concurrently in patients suspected of having symptomatic cerebral vasospasm postoperatively. The presence and severity of vasospasm were estimated according to location (proximal versus distal). Vasospasm >50% was defined as having hemodynamic significance. Vasospasms <30% were excluded from this analysis to avoid spectrum bias. Twenty-nine patients (311 vessel segments) were measured. The intra- and interobserver agreements were excellent for depicting vasospasm (k = 0.84 and 0.74, resp.). IV FDCT showed a sensitivity of 95.7%, specificity of 92.3%, positive predictive value of 93.6%, and negative predictive value of 94.7% for detecting vasospasm (>50%) with DSA as the reference. Bland-Altman plots revealed good agreement of assessing vasospasm between the two tests. The discrepancy of vasospasm severity was more noted in the distal location with high-severity. However, it was not statistically significant (Spearman's rank test; r = 0.15, P = 0.35). Therefore, IV FDCT could be a feasible noninvasive test to evaluate suspected significant vasospasm in SAH. PMID:25383367

  9. Intravenous thrombolysis for acute ischemic stroke.

    PubMed

    Turc, G; Isabel, C; Calvet, D

    2014-12-01

    Intravenous thrombolysis (IVT) with alteplase remains the standard treatment for acute ischemic stroke. Although IVT can be started up to 4.5 hours after symptoms' onset, it is all the more effective and safe when started early. It allows a 10% absolute reduction in the risk of handicap or death at 3 months, despite a 2-7% risk of symptomatic intracranial hemorrhage. Current research efforts involve firstly trying to treat a larger proportion of patients by overcoming some of the contraindications to IVT and secondly assessing combined or alternative treatments to achieve a higher early recanalization rate. PMID:25465121

  10. Treatment of refractory epilepsy with intravenous immunoglobulins

    Microsoft Academic Search

    K. van Rijckevorsel-Harmant; M. Delire; W. Schmitz-Moorman; H. G. Wieser

    1994-01-01

    Summary  Sixty-one refractory epileptic patients (46 with partial epilepsy) were treated with intravenous immunoglobulins in a controlled\\u000a double-blind\\/dose finding clinical trial; 18 (7 females, mean age 18.5 years) received placebo, while 14 (3 females, mean\\u000a age 26.2 years, 2 excluded), 14 (4 females, mean age 24.6 years, 1 excluded) and 15 (5 females, mean age 24.4 years) patients\\u000a received 100, 250

  11. Improved Arterial Blood Oxygenation Following Intravenous Infusion of Cold Supersaturated Dissolved Oxygen Solution

    PubMed Central

    Grady, Daniel J; Gentile, Michael A; Riggs, John H; Cheifetz, Ira M

    2014-01-01

    BACKGROUND One of the primary goals of critical care medicine is to support adequate gas exchange without iatrogenic sequelae. An emerging method of delivering supplemental oxygen is intravenously rather than via the traditional inhalation route. The objective of this study was to evaluate the gas-exchange effects of infusing cold intravenous (IV) fluids containing very high partial pressures of dissolved oxygen (>760 mm Hg) in a porcine model. METHODS Juvenile swines were anesthetized and mechanically ventilated. Each animal received an infusion of cold (13 °C) Ringer’s lactate solution (30 mL/kg/hour), which had been supersaturated with dissolved oxygen gas (39.7 mg/L dissolved oxygen, 992 mm Hg, 30.5 mL/L). Arterial blood gases and physiologic measurements were repeated at 15-minute intervals during a 60-minute IV infusion of the supersaturated dissolved oxygen solution. Each animal served as its own control. RESULTS Five swines (12.9 ± 0.9 kg) were studied. Following the 60-minute infusion, there were significant increases in PaO2 and SaO2 (P < 0.05) and a significant decrease in PaCO2 (P < 0.05), with a corresponding normalization in arterial blood pH. Additionally, there was a significant decrease in core body temperature (P < 0.05) when compared to the baseline preinfusion state. CONCLUSIONS A cold, supersaturated dissolved oxygen solution may be intravenously administered to improve arterial blood oxygenation and ventilation parameters and induce a mild therapeutic hypothermia in a porcine model. PMID:25249764

  12. Determination of threshold dose with delta-aminolevulinic acid-induced porphyrins for effective photodynamic therapy

    NASA Astrophysics Data System (ADS)

    Fritsch, Clemens; Abels, Christoph; Bolsen, Klaus; Ruzicka, Thomas; Goetz, Alwin E.; Goerz, Guenter

    1995-03-01

    In this study the metabolism in tumors and various tissues of intravenously administered (delta) -aminolevulinic acid was investigated. Amelanotic melanoma (A-Mel-3) were implanted in the dorsal skin of Syrian golden hamsters. Distribution and metabolism of i.v. injected (delta) -aminolevulinic acid in blood was studied by determination of (delta) - aminolevulinic acid and protoporphyrin concentration in red blood cells. In addition extraction of various tissues, e.g. tumor, liver, kidney, and normal skin was performed, to verify fluorescence kinetic studies by determination of total porphyrin concentration by photometry and of distribution of the porphyrin metabolites by HPLC. In untreated animals the total porphyrin concentration in all tissues examined were comparably low. In red blood cells the maximal concentration of (delta) -aminolevulinic acid as well as protoporphyrin was detected 45 min after i.v. injection of (delta) -aminolevulinic acid. Porphyrins accumulated in melanoma reaching a maximum tumor:skin tissue ratio of 6.9:1 at 45 min after i.v. injection of (delta) -aminolevulinic acid. A second high tumor:skin tissue ratio of 5.7:1 could be measured at 24 h after injection, but at this point in time the protoporphyrin content in normal skin was higher than 45 min after injection. The kidney may not be strongly affected by i.v. administration of (delta) -aminolevulinic acid, whereas the liver reveals an accumulation of porphyrins, e.g. protoporphyrin. Concluding from these results in this experimental tumor model, i.v. administration of (delta) -aminolevulinic acid seems to be a promising modality to perform photodynamic therapy more effectively and more selectively by irradiation 45 - 180 min after injection of (delta) -aminolevulinic acid.

  13. Pharmacokinetics and Pharmacodynamics of Intravenous Daptomycin during Continuous Ambulatory Peritoneal Dialysis

    PubMed Central

    Cardone, Katie E.; Patel, Nimish; Hoy, Christopher D.; Meola, Shari; Manley, Harold J.; Drusano, George L.; Grabe, Darren W.

    2011-01-01

    Summary Background and objectives This study sought to (1) characterize the pharmacokinetic (PK) profile of intravenous (IV) daptomycin among patients receiving continuous ambulatory peritoneal dialysis (CAPD); (2) identify optimal IV CAPD dosing schemes; and (3) determine extent of daptomycin penetration into the peritoneal space after IV administration. Design, setting, participants, & measurements A PK study was conducted among eight CAPD patients. Population PK modeling and Monte Carlo simulation (MCS) were used to identify CAPD dosing schemes providing efficacy and toxicity plasma profiles comparable with those obtained from MCS using the daptomycin population PK model derived from patients in the Staphylococcus aureus bacteremia-infective endocarditis (SAB-IE) study. The primary efficacy exposure target was the area under the curve (AUC). For toxicity, the goal was to identify CAPD dosing schemes that minimized plasma trough concentrations in excess of 24.3 mg/L. Finally, peritoneal cavity penetration was determined. Results Administration of IV daptomycin 4 or 6 mg/kg, depending on indication, every 48 h was identified as the optimal CAPD dosing scheme. This regimen provided cumulative (AUC0–48) and daily partitioned (AUC0–24h and AUC24–48h) plasma AUC values similar to the SAB-IE or “typical patient” simulations. In addition, the proportion of patients likely to experience an elevated trough concentration in excess of 24.3 mg/L was similar between every 48 h CAPD dosing and the referent group. Penetration into the peritoneal cavity was 6% of plasma. Conclusions Daptomycin 4 or 6 mg/kg, on the basis of indication, IV every 48 h was found to be the optimal IV CAPD dosing scheme. PMID:21393490

  14. Intravenous iron treatment in paediatric chronic kidney disease patients not on erythropoietin.

    PubMed

    Morgan, Henry E G; Holt, Richard C L; Jones, Caroline A; Judd, Brian A

    2007-11-01

    Intravenous (i.v.) iron treatment reduces erythropoietin (EPO) dose in paediatric haemodialysis patients. The efficacy in paediatric nonhaemodialysis patients is less well established. i.v. iron is routinely given in our institution to these patients, including some who have not started EPO. The effect of this strategy was examined. Patients with chronic kidney disease (CKD) or peritoneal dialysis (PD) not on EPO were identified. Case notes were reviewed for haemoglobin (Hb), red cell and iron indices for 6 months before and at least 3 months after i.v. iron. Five patients were identified. Mean age was 13.3 years and mean i.v. iron (Venofer) dose = 3.1 mg/kg. Median number of doses = 7 (range 3-10). Hb increased significantly after i.v. iron from 11.4 +/- 0.7 to 12.8 +/- 1.3 g/dl (p = 0.02). Mean cell volume increased from 87.7+/-3.4 to 90.1 +/- 3.7 fl (p = 0.01), and mean cell Hb remained unchanged: 29.2 +/- 1.2 to 29.7 +/- 1.0 pg (p = 0.12). Absolute and percentage reticulocyte count remained unchanged. There was no change in iron indices: ferritin 55.1 +/- 31.3 to 97.3 +/- 46.5 ng/ml (p = 0.3), iron 18.9 +/- 6.9 to 18.1 +/- 4.2 micromol/l (p = 0.7), transferrin 1.9 +/- 1.6 to 2.0 +/- 0.1 g/l (p = 1.0), transferrin saturation 35.7 +/- 8.1 to 40.3 +/- 18.0% (p = 0.5). i.v. iron slightly improved Hb levels in five paediatric CKD and PD patients not receiving EPO. This strategy may delay the need for EPO treatment and deserves further evaluation. PMID:17704954

  15. Carboplatin and Paclitaxel or Oxaliplatin and Capecitabine With or Without Bevacizumab as First-Line Therapy in Treating Patients With Newly Diagnosed Stage II-IV or Recurrent Stage I Epithelial Ovarian or Fallopian Tube Cancer

    ClinicalTrials.gov

    2015-04-09

    Borderline Ovarian Mucinous Tumor; Ovarian Mucinous Cystadenocarcinoma; Recurrent Fallopian Tube Carcinoma; Recurrent Ovarian Carcinoma; Stage IA Fallopian Tube Cancer; Stage IA Ovarian Cancer; Stage IB Fallopian Tube Cancer; Stage IB Ovarian Cancer; Stage IC Fallopian Tube Cancer; Stage IC Ovarian Cancer; Stage IIA Fallopian Tube Cancer; Stage IIA Ovarian Cancer; Stage IIB Fallopian Tube Cancer; Stage IIB Ovarian Cancer; Stage IIC Fallopian Tube Cancer; Stage IIC Ovarian Cancer; Stage IIIA Fallopian Tube Cancer; Stage IIIA Ovarian Cancer; Stage IIIB Fallopian Tube Cancer; Stage IIIB Ovarian Cancer; Stage IIIC Fallopian Tube Cancer; Stage IIIC Ovarian Cancer; Stage IV Fallopian Tube Cancer; Stage IV Ovarian Cancer

  16. Safety and Efficacy of Intravenous Ferric Carboxymaltose (750?mg) in the Treatment of Iron Deficiency Anemia: Two Randomized, Controlled Trials

    PubMed Central

    Barish, Charles F.; Koch, Todd; Butcher, Angelia; Morris, David; Bregman, David B.

    2012-01-01

    Background. Iron deficiency anemia (IDA) is a common hematological complication with potentially serious clinical consequences that may require intravenous iron therapy. Ferric carboxymaltose (FCM) is a stable, nondextran iron formulation administered intravenously in large single doses to treat IDA. Objective. Two open-label, randomized, placebo-controlled trials evaluated safety of multiple or single 750?mg FCM doses compared to standard medical care (SMC) in IDA patients. Secondary endpoints were improvements in hemoglobin and iron indices. Design and Patients. Adults with hemoglobin ?12?g/dL, ferritin ?100 or ?300?ng/mL with transferrin saturation ?30% were randomized to receive single (n = 366) or weekly (n = 343) FCM or SMC (n = 360 and n = 366). Results. Significantly greater (P ? 0.001) increases in hemoglobin and iron indices occurred in FCM groups versus SMC. In the multidose study, up to two infusions of FCM were needed to reach target iron levels versus 3–5 of intravenous iron comparators. FCM and SMC groups had similar incidences and types of adverse events and serious adverse events. Transient hypophosphatemia not associated with adverse events or clinical sequelae occurred in the FCM groups. Conclusion. Intravenous FCM is safe, well tolerated, and associated with improvements in hemoglobin and iron indices comparable to SMC when administered in single doses of up to 750?mg at a rate of 100?mg/min. Fewer FCM infusions were required to reach target iron levels compared to other intravenous iron preparations. PMID:22997572

  17. [Intravenous regional anesthesia of the arm].

    PubMed

    Biscoping, J

    1993-01-01

    Intravenous regional anesthesia is a well established technique since the start of this century. It is easy to perform, with rapid onset of analgesia and safe to practice, when proper patient monitoring (ECG, intermittent blood pressure monitoring, oxygen delivery by nasal insufflation) is established and a local anesthetic solution with low systemic toxicity (e.g. prilocaine) is used. When choosing this technique of regional anesthesia it is an important condition, that the operative procedure has to be finished before the tourniquet of the upper arm is released. Immediately after this cuff-release and recirculation of the arm analgesia will diminish. When using prilocaine or mepivacaine as local anesthetic drug a complete surgical analgesia of 30 up to 45 min can be achieved. Long-acting local anesthetics should not be used because of their increased systemic toxicity under the aspect of drug wash-out at the end of the procedure or in terms of inadvertent cuff release. The site of action of intravenous regional anesthesia has been controversial, since adequate clinical investigations with contrast media and radio isotopes proved, that the principal site of action is at the peripheral nerve endings. PMID:8379170

  18. Panlobular emphysema in young intravenous Ritalin abusers

    SciTech Connect

    Schmidt, R.A.; Glenny, R.W.; Godwin, J.D.; Hampson, N.B.; Cantino, M.E.; Reichenbach, D.D. (Univ. of Washington, Seattle (USA))

    1991-03-01

    We studied a distinctive group of young intravenous Ritalin abusers with profound obstructive lung disease. Clinically, they seemed to have severe emphysema, but the pathologic basis of their symptoms had not been investigated previously. Seven patients have died and been autopsied: in four, the lungs were fixed, inflated, dried, and examined in detail radiologically, grossly, microscopically, and by electron probe X-ray microanalysis. All seven patients had severe panlobular (panacinar) emphysema that tended to be more severe in the lower lung zones and that was associated with microscopic talc granulomas. Vascular involvement by talc granulomas was variable, but significant interstitial fibrosis was not present. Five patients were tested for alpha-1-antitrypsin deficiency and found to be normal, as were six similar living patients. These findings indicate that some intravenous drug abusers develop emphysema that clinically, radiologically, and pathologically resembles that caused by alpha-1-antitrypsin deficiency but which must have a different pathogenesis. Talc from the Ritalin tablets may be important, but the mechanism remains to be elucidated.

  19. Benefits of intravenous lidocaine on post-operative pain and acute rehabilitation after laparoscopic nephrectomy

    PubMed Central

    Tauzin-Fin, Patrick; Bernard, Olivier; Sesay, Musa; Biais, Matthieu; Richebe, Philippe; Quinart, Alice; Revel, Philippe; Sztark, Francois

    2014-01-01

    Background and Aims: Intravenous (I.V.) lidocaine has analgesic, antihyperalgesic and anti-inflammatory properties and is known to accelerate the return of bowel function after surgery. We evaluated the effects of I.V. lidocaine on pain management and acute rehabilitation protocol after laparoscopic nephrectomy. Materials and Methods: A total of 47 patients scheduled to undergo laparoscopic nephrectomy were included in a two-phase observational study where I.V. lidocaine (1.5 mg/kg/h) was introduced, in the second phase, during surgery and for 24 h post-operatively. All patients underwent the same post-operative rehabilitation program. Post-operative pain scores, opioid consumption and extent of hyperalgesia were measured. Time to first flatus and 6 min walking test (6MWT) were recorded. Results: Patient demographics were similar in the two phases (n = 22 in each group). Lidocaine significantly reduced morphine consumption (median [25-75% interquartile range]; 8.5 mg[4567891011121314151617] vs. 25 mg[1920212223242526272829303132]; P < 0.0001), post-operative pain scores (P < 0.05) and hyperalgesia extent on post-operative day 1-day 2-day 4 (mean ± standard deviation (SD); 1.5 ± 0.9 vs. 4.3 ± 1.2 cm (P < 0.001), 0.6 ± 0.5 vs. 2.8 ± 1.2 cm (P < 0.001) and 0.13 ± 0.3 vs. 1.2 ± 1 cm (P < 0.001), respectively). Time to first flatus (mean ± SD; 29 ± 7 h vs. 48 ± 15 h; P < 0.001) and 6MWT at day 4 (189 ± 50 m vs. 151 ± 53 m; P < 0.001) were significantly enhanced in patients with i.v. lidocaine. Conclusion: Intravenous (I.V.) lidocaine could reduce post-operative morphine consumption and improve post-operative pain management and post-operative recovery after laparoscopic nephrectomy. I.V. lidocaine could contribute to better post-operative rehabilitation. PMID:25190945

  20. Intravenous immunoglobulin promotes antitumor responses by modulating macrophage polarization.

    PubMed

    Domínguez-Soto, Angeles; de las Casas-Engel, Mateo; Bragado, Rafael; Medina-Echeverz, José; Aragoneses-Fenoll, Laura; Martín-Gayo, Enrique; van Rooijen, Nico; Berraondo, Pedro; Toribio, María L; Moro, María A; Cuartero, Isabel; Castrillo, Antonio; Sancho, David; Sánchez-Torres, Carmen; Bruhns, Pierre; Sánchez-Ramón, Silvia; Corbí, Angel L

    2014-11-15

    Intravenous Igs (IVIg) therapy is widely used as an immunomodulatory strategy in inflammatory pathologies and is suggested to promote cancer regression. Because progression of tumors depends on their ability to redirect the polarization state of tumor-associated macrophages (from M1/immunogenic/proinflammatory to M2/anti-inflammatory), we have evaluated whether IVIg limits tumor progression and dissemination through modulation of macrophage polarization. In vitro, IVIg inhibited proinflammatory cytokine production from M1 macrophages and induced a M2-to-M1 polarization switch on human and murine M2 macrophages. In vivo, IVIg modified the polarization of tumor-associated myeloid cells in a Fc?r1? chain-dependent manner, modulated cytokine blood levels in tumor-bearing animals, and impaired tumor progression via Fc?RIII (CD16), Fc?RIV, and FcR? engagement, the latter two effects being macrophage mediated. Therefore, IVIg immunomodulatory activity is dependent on the polarization state of the responding macrophages, and its ability to trigger a M2-to-M1 macrophage polarization switch might be therapeutically useful in cancer, in which proinflammatory or immunogenic functions should be promoted. PMID:25326025

  1. Intravenous mannitol does not increase blood-brain barrier permeability to inert dyes in the adult rat forebrain.

    PubMed

    Chen, Kuen-Bao; Wei, Vivi Chiali; Yen, Lola Fenghuei; Poon, Kin-Shing; Liu, Yu-Cheng; Cheng, Ka-Shun; Chang, Chia-Sheng; Lai, Ted Weita

    2013-04-17

    Intravenous mannitol (IV-M) is widely administered in the clinic to lower intracranial pressure in patients with brain trauma and stroke. However, intracarotid arterial mannitol (ICA-M) is known to potently open the blood-brain barrier (BBB) to serum protein tracers such as the Evans blue dye (EBD). In this study, we aimed to determine the potential effect of IV-M on BBB permeability to EBD and a small molecular tracer sodium fluorescein dye (NaF). Rats received intravenous EBD/NaF injections, and after a 30-min equilibration time, they received mannitol (20%, 0.5 g/kg) through either route of administration. At 90 min after the mannitol injection, the rats were perfused to rid their circulations of the tracers, and the tracers extravasated into the brain parenchyma were measured by photospectrometry. As expected, ICA-M considerably increased EBD extravasation into the rat forebrain regions, including the motor cortex (P=0.0069), the striatum (P=0.0097), and the hippocampus (P=0.0281; student's t-test). In marked contrast, IV-M exerted no effect on EBD extravasation into these forebrain regions. To increase the power of the IV-M study, we repeated the experiments in two independent trials of experiments (n=6-9/group/trial) and found the same result. Finally, consistent with no effect on EBD extravasation, IV-M had no effect on NaF extravasation into the rat forebrain. In conclusion, we report direct evidence that IV-M, at a dose used clinically, in contrast to the same dose of ICA-M, exerted no effect on BBB permeability to protein and small molecular tracers. PMID:23426109

  2. Topical and intravenous pilocarpine stimulated accommodation in anesthetized rhesus monkeys

    PubMed Central

    Wendt, Mark; Glasser, Adrian

    2010-01-01

    Many studies have used pilocarpine to stimulate accommodation in both humans and monkeys. However, the concentrations of pilocarpine used and the methods of administration vary. In this study, three different methods of pilocarpine administration are evaluated for their effectiveness in stimulating accommodation in rhesus monkeys. Experiments were performed in 17 iridectomized, anesthetized rhesus monkeys aged 4–16 years. Maximum accommodation was stimulated in all these monkeys with a 2% pilocarpine solution maintained on the cornea for at least 30 min in a specially designed perfusion lens. In subsequent topical pilocarpine experiments, baseline refraction was measured with a Hartinger coincidence refractometer and then while the monkeys were upright and facing forward, commercially available pilocarpine (2, 4, or 6%) was applied topically to the cornea as 2 or 4 drops in two applications or 6 drops in three applications over a five minute period with the eyelids closed between applications. Alternatively, while supine, 10–12 drops of pilocarpine were maintained on the cornea in a scleral cup for 5 min. Refraction measurements were begun 5 min after the second application of pilocarpine and continued for at least 30 min after initial administration until no further change in refraction occurred. In intravenous experiments, pilocarpine was given either as boluses ranging from 0.1 mg/kg to 2 mg/kg or boluses followed by a constant infusion at rates between 3.06 mg/kg/h and 11.6 mg/kg/h. Constant 2% pilocarpine solution on the eye in the perfusion lens produced 10.88 ± 2.73 D (mean ± SD) of accommodation. Topically applied pilocarpine produced 3.81 D ± 2.41, 5.49 D ± 4.08, and 5.55 D ± 3.27 using 2%, 4%, and 6% solutions respectively. When expressed as a percentage of the accommodative response amplitude obtained in the same monkey with constant 2% pilocarpine solution on the eye, the responses were 34.7% for 2% pilocarpine, 48.4% for 4% pilocarpine, and 44.6% for 6% pilocarpine. Topical 4% and 6% pilocarpine achieved similar, variable accommodative responses, but neither achieved maximum accommodation. IV boluses of pilocarpine achieved near maximal levels of accommodation at least ten times faster than topical methods. Doses effective for producing maximum accommodation ranged from 0.25 mg/kg to 1.0 mg/kg. IV pilocarpine boluses caused an anterior movement of the anterior lens surface, a posterior movement of the posterior lens surface, and a slight net anterior movement of the entire lens. Considerable variability in response amplitude occurred and maximum accommodative amplitude was rarely achieved with topical application of a variety of concentrations of commercially available pilocarpine. Intravenous infusion of pilocarpine was a rapid and reliable method of producing a nearly maximal accommodative response and maintaining accommodation when desired. PMID:20159011

  3. Therapy for vasculitic neuropathies.

    PubMed

    Gorson, Kenneth C

    2006-03-01

    The term vasculitis refers to a pathologic condition defined by inflammatory cell infiltration and destruction of blood vessels. Systemic vasculitis is classified as primary (eg, polyarteritis nodosa, Churg-Strauss syndrome) or secondary, the latter associated with connective tissue disorders, infections, medications, and rarely, as a paraneoplastic phenomenon. Neuropathy is a common complication of systemic vasculitis and is related to ischemic nerve fiber damage with axon loss. Peripheral neuropathy may be the sole manifestation of vasculitis, a condition termed nonsystemic vasculitic neuropathy (NSVN). Treatment of vasculitic neuropathy requires long-term immunosuppressive therapies with potential side effects. The diagnosis of vasculitis should be established by tissue (preferably nerve) biopsy. High-dose prednisone is the standard platform therapy for patients with systemic and NSVN; for those with systemic vasculitis, at least 3 to 12 months of treatment with cyclophosphamide (monthly intravenous pulse or daily oral therapy) is also necessary to sustain remission and allow successful prednisone tapering. The use of cyclophosphamide in patients with NSVN is controversial, but recent retrospective data suggest that those treated with prednisone and cyclophosphamide from the outset fare better than those initially treated only with prednisone. If prednisone is administered as monotherapy, cyclophosphamide should be added after several months if there is no improvement or relapse occurs with tapering of prednisone. Intravenous pulse and daily oral cyclophosphamide probably offer similar efficacy, although the risk of complications is greater with oral therapy. Azathioprine can be safely substituted for cyclophosphamide after 3 months without an increased relapse rate. Azathioprine, methotrexate, intravenous immune globulin, mycophenolate mofetil, plasma exchange, and rituximab can be offered to patients who are intolerant or have a contraindication to cyclophosphamide. However, efficacy is unproven for any of these therapies. Interferon-alpha, sometimes combined with plasma exchange, is used to treat vasculitis associated with hepatitis B infection. Some patients also may improve with corticosteroids. The classification of diabetic lumbosacral radiculoplexus neuropathy as a vasculitic disorder remains controversial. However, there is compelling pathological evidence that this condition represents a T-cell-mediated microvasculitis. Some patients treated with intravenous corticosteroids may have greater recovery and improved pain control. PMID:16464407

  4. Pharmacokinetics of tobramycin following intravenous, intramuscular, and intra-articular administration in healthy horses.

    PubMed

    Newman, J C; Prange, T; Jennings, S; Barlow, B M; Davis, J L

    2013-12-01

    The objectives of this study were to examine the pharmacokinetics of tobramycin in the horse following intravenous (IV), intramuscular (IM), and intra-articular (IA) administration. Six mares received 4 mg/kg tobramycin IV, IM, and IV with concurrent IA administration (IV+IA) in a randomized 3-way crossover design. A washout period of at least 7 days was allotted between experiments. After IV administration, the volume of distribution, clearance, and half-life were 0.18 ± 0.04 L/kg, 1.18 ± 0.32 mL·kg/min, and 4.61 ± 1.10 h, respectively. Concurrent IA administration could not be demonstrated to influence IV pharmacokinetics. The mean maximum plasma concentration (Cmax ) after IM administration was 18.24 ± 9.23 ?g/mL at 1.0 h (range 1.0-2.0 h), with a mean bioavailability of 81.22 ± 44.05%. Intramuscular administration was well tolerated, despite the high volume of drug administered (50 mL per 500 kg horse). Trough concentrations at 24 h were below 2 ?g/mL in all horses after all routes of administration. Specifically, trough concentrations at 24 h were 0.04 ± 0.01 ?g/mL for the IV route, 0.04 ± 0.02 ?g/mL for the IV/IA route, and 0.02 ± 0.02 for the IM route. An additional six mares received IA administration of 240 mg tobramycin. Synovial fluid concentrations were 3056.47 ± 1310.89 ?g/mL at 30 min after administration, and they persisted for up to 48 h with concentrations of 14.80 ± 7.47 ?g/mL. Tobramycin IA resulted in a mild chemical synovitis as evidenced by an increase in synovial fluid cell count and total protein, but appeared to be safe for administration. Monte Carlo simulations suggest that tobramycin would be effective against bacteria with a minimum inhibitory concentration (MIC) of 2 ?g/mL for IV administration and 1 ?g/mL for IM administration based on Cmax :MIC of 10. PMID:23531033

  5. Pharmacokinetics and perioperative efficacy of intravenous ketorolac in dogs.

    PubMed

    Cagnardi, P; Zonca, A; Gallo, M; Villa, R; Carli, S; Beccaglia, M; Fonda, D; Ravasio, G

    2013-12-01

    Ketorolac (KET) is a nonsteroidal anti-inflammatory drug approved for the use in humans that possesses a potent analgesic activity, comparable to morphine, and could represent a useful tool to control acute pain also in animals. The clinical efficacy and pharmacokinetic profile of intravenous (IV) ketorolac tromethamine (0.5 mg/kg) were studied in 15 dogs undergoing gonadectomy. Intra-operative cardiorespiratory variables were monitored, and post-operative pain was assessed using a subjective pain score (0-24) in all dogs, whereas the pharmacokinetic profile of the drug was determined in 10 animals. During surgery, mean minimal alveolar concentration of isoflurane was 1.69 ± 0.11%, and normocapnia and spontaneous ventilation were maintained in all animals. During pain assessment, no significant differences between males and females were found, and in no case rescue analgesia was necessary. No adverse effects were reported. Serum samples were purified by solid-phase extraction and analysed by HPLC with UV-Vis detection. A large variability was observed in serum concentrations. The kinetics of ketorolac was described by a noncompartmental analysis. The elimination half-life (t½?z ) and ClB were 10.95 ± 7.06 h and 92.66 ± 84.49 mL/h/kg, respectively, and Vdss and Vz were 1030.09 ± 620.50 mL/kg and 1512.25 ± 799.13 mL/kg, respectively. AUC(0?last) and MRT(0?last) were 6.08 ± 3.28 h × ?g/mL and 5.59 ± 2.12 h, respectively. The results indicate that ketorolac possess good post-operative analgesic effects until about 6 h after administration in dogs undergoing moderately painful surgery. PMID:23473380

  6. Adverse Drug Reactions of Long-term Intravenous Antibiotics in Patients with Pyogenic Spondylitis

    PubMed Central

    Kim, Dong Hwan; Kim, Hwan Soo; Nam, Kyoung Hyup; Choi, Byung Kwan

    2014-01-01

    Objective The purpose of this study was to investigate the incidence, cause, and influence of the adverse drug reactions (ADRs) associated with long-term intravenous antibiotics in patients with pyogenic spondylitis (PS). Methods We retrospectively reviewed the medical records of 84 patients with PS who underwent intravenous antibiotic therapy in our hospital from January 2001 to December 2012. ADRs were categorized to drug eruption, acute renal failure (ARF), hematologic toxicity, toxic hepatitis, pseudomembranous colitis (PMC), drug fever, and neuronal toxicity. Incidence and onset time of each ADR after antibiotic therapy were analyzed with the incidence of ADRs according to types of antibiotics. Results ADRs occurred in 38 of the 84 patients (incidence: 45.2%). The use of antibiotics was longer in the patients with ADRs (62.7 days) than in the patients without ADRs (44.3 day). The incidence of drug eruption, ARF, hematologic toxicity, toxic hepatitis, PMC, drug fever, and neuronal toxicity were 22.6, 11.9, 11.9, 10.7, 7.1, 3.6%, and 1.2%, respectively. The duration of antibiotics administration was related to the occurrence of PMC (p=0.001). ADRs were more common in patients treated by glycopeptides including vacomycin and teicoplanin. Conclusion The incidence of ADRs due to long-term intravenous antibiotics was as high as 45.2% in patients with PS. Therefore, we speculate that the possibility of delayed ADRs should be considered after long-term use of the antibiotics. Furthermore, close observation is mandatory to identify and treat ADRs promptly, even though PS revealed the improvement after antibiotic therapy. PMID:25346755

  7. Effectiveness of external cold and vibration for procedural pain relief during peripheral intravenous cannulation in pediatric patients.

    PubMed

    Canbulat, Nejla; Ayhan, Fatma; Inal, Sevil

    2015-02-01

    The aim of this study was to investigate the effect of external cold and vibration stimulation via Buzzy on the pain and anxiety level of children during peripheral intravenous (IV) cannulation. This study was a prospective, randomized controlled trial. The sample consisted of 176 children ages 7 to 12 years who were randomly assigned to two groups: a control group that received no peripheral IV cannulation intervention and an experimental group that received external cold and vibration via Buzzy. The same nurse conducted the peripheral IV cannulation in all the children, and the same researcher applied the external cold and vibration to all the children. The external cold and the vibration were applied 1 minute before the peripheral IV cannulation procedure and continued until the end of the procedure. Preprocedural anxiety was assessed using the Children's Fear Scale, along with reports by the children, their parents, and an observer. Procedural anxiety was assessed with the Children's Fear Scale and the parents' and the observer's reports. Procedural pain was assessed using the Wong Baker Faces Scale and the visual analog scale self-reports of the children. Preprocedural anxiety did not differ significantly. Comparison of the two groups showed significantly lower pain and anxiety levels in the experimental group than in the control group during the peripheral IV cannulation. Buzzy can be considered to provide an effective combination of coldness and vibration. This method can be used during pediatric peripheral IV cannulation by pediatric nurses. PMID:24912740

  8. Effect of ? -Lipoic Acid on Oxidative Stress in End-Stage Renal Disease Patients Receiving Intravenous Iron.

    PubMed

    Showkat, Arif; Bastnagel, William R; Hudson, Joanna Q

    2014-01-01

    Oxidative stress is associated with increased risk of cardiovascular disease in end-stage renal disease (ESRD) patients. Intravenous (IV) iron has been shown to increase oxidative stress. The aim of the study was to evaluate changes in oxidative stress markers following administration of IV sodium ferric gluconate (SFG) to ESRD patients with and without administration of the antioxidant, ? -lipoic acid. This is an open-label, crossover study. 125?mg of IV SFG was administered during control (C) and intervention (I) visits. During the I visit, 600?mg of ? -lipoic acid was given orally prior to IV SFG. Blood samples were collected at defined time periods for F2-isoprostane (FIP), lipid hydroperoxide (LHP), malondialdehyde (MDA), and iron indices. We recruited ten African-American ESRD subjects: 50% male; mean age 45 ± 9 years; mean hemoglobin 13 ± 1?g/dL; ferritin 449 ± 145?ng/mL; transferrin saturation 27 ± 4%. There were no significant differences in iron indices between the two visits after IV SFG. MDA, FIP, and LHP increased significantly for both C and I visits with a greater increase in the I group. Administration of IV SFG results in an acute rise in oxidative stress in ESRD patients. In contrast to previous studies, administration of ? -lipoic acid was associated with a greater increase in oxidative stress. PMID:24967245

  9. Effect of ?-Lipoic Acid on Oxidative Stress in End-Stage Renal Disease Patients Receiving Intravenous Iron

    PubMed Central

    Showkat, Arif; Bastnagel, William R.; Hudson, Joanna Q.

    2014-01-01

    Oxidative stress is associated with increased risk of cardiovascular disease in end-stage renal disease (ESRD) patients. Intravenous (IV) iron has been shown to increase oxidative stress. The aim of the study was to evaluate changes in oxidative stress markers following administration of IV sodium ferric gluconate (SFG) to ESRD patients with and without administration of the antioxidant, ?-lipoic acid. This is an open-label, crossover study. 125?mg of IV SFG was administered during control (C) and intervention (I) visits. During the I visit, 600?mg of ?-lipoic acid was given orally prior to IV SFG. Blood samples were collected at defined time periods for F2-isoprostane (FIP), lipid hydroperoxide (LHP), malondialdehyde (MDA), and iron indices. We recruited ten African-American ESRD subjects: 50% male; mean age 45 ± 9 years; mean hemoglobin 13 ± 1?g/dL; ferritin 449 ± 145?ng/mL; transferrin saturation 27 ± 4%. There were no significant differences in iron indices between the two visits after IV SFG. MDA, FIP, and LHP increased significantly for both C and I visits with a greater increase in the I group. Administration of IV SFG results in an acute rise in oxidative stress in ESRD patients. In contrast to previous studies, administration of ?-lipoic acid was associated with a greater increase in oxidative stress. PMID:24967245

  10. Prospective study evaluating the use of IV contrast on IMRT treatment planning for lung cancer

    SciTech Connect

    Li, Hua, E-mail: huli@radonc.wustl.edu; Bottani, Beth; DeWees, Todd; Michalski, Jeff M.; Mutic, Sasa; Bradley, Jeffrey D.; Robinson, Clifford G. [Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri 63110 (United States)] [Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri 63110 (United States); Low, Daniel A. [Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California 90095 (United States)] [Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California 90095 (United States)

    2014-03-15

    Purpose: To investigate the impact of exclusively using intravenous (IV) contrast x-ray computed tomography (CT) scans on lung cancer intensity-modulated radiation therapy (IMRT) treatment planning. Methods: Eight patients with lung cancer (one small cell, seven nonsmall cell) scheduled to receive IMRT consented to acquisition of simulation CT scans with and without IV contrast. Clinical treatment plans optimized on the noncontrast scans were recomputed on contrast scans and dose coverage was compared, along with the ? passing rates. Results: IV contrast enhanced scans provided better target and critical structure conspicuity than the noncontrast scans. Using noncontrast scan as a reference, the median absolute/relative differences in mean, maximum, and minimum doses to the planning target volume (PTV) were ?4.5 cGy/?0.09%, 41.1 cGy/0.62%, and ?19.7 cGy/?0.50%, respectively. Regarding organs-at-risk (OARs), the median absolute/relative differences of maximum dose to heart was ?13.3 cGy/?0.32%, to esophagus was ?63.4 cGy/?0.89%, and to spinal cord was ?16.3 cGy/?0.46%. The median heart region of interest CT Hounsfield Unit (HU) number difference between noncontrast and contrast scans was 136.4 HU (range, 94.2–161.8 HU). Subjectively, the regions with absolute dose differences greater than 3% of the prescription dose were small and typically located at the patient periphery and/or at the beam edges. The median ? passing rate was 0.9981 (range, 0.9654–0.9999) using 3% absolute dose difference/3 mm distance-to-agreement criteria. Overall, all evaluated cases were found to be clinically equivalent. Conclusions: PTV and OARs dose differences between noncontrast and contrast scans appear to be minimal for lung cancer patients undergoing IMRT. Using IV contrast scans as the primary simulation dataset could increase treatment planning efficiency and accuracy by avoiding unnecessary scans, manually region overriding, and planning errors caused by nonperfect image registrations.

  11. Stroke Mimic Secondary to IV Fentanyl Administration

    PubMed Central

    Uhegwu, Nnamdi; Bashir, Asif; Dababneh, Haitham; Hussain, Mohammed; Misthal, Sara; Mocco, J Duffy

    2015-01-01

    Fentanyl is a potent opioid used commonly in acute care because of its rapid onset and short duration of action. It has fewer side effects when compared with commonly available opioids, such as morphine and hydromorphine. We report an unusual side effect of transient aphasia following fentanyl administration. A 61-year-old female presented for an elective embolization of a periophthalmic artery aneurysm. She developed immediate episodes of aphasia on two separate occasions following administration of intravenous (IV) fentanyl. The high lipid solubility explains the rapid onset of action of fentanyl as it rapidly passes through the blood–brain barrier and through cell membranes. Immediately following the administration of fentanyl, the patient developed aphasia. There were no other clinical or neurological imaging findings that could account for these symptoms. We believe that aphasia may be an unusual side effect of fentanyl, and it is something clinicians should be aware of.

  12. Ifosfamide, methotrexate, etoposide, and prednisolone (IMEP) plus L-asparaginase as a first-line therapy improves outcomes in stage III/IV NK/T cell-lymphoma, nasal type (NTCL).

    PubMed

    Kim, Miso; Kim, Tae Min; Kim, Ki Hwan; Keam, Bhumsuk; Lee, Se-Hoon; Kim, Dong-Wan; Lee, Jong Seok; Jeon, Yoon Kyung; Kim, Chul Woo; Heo, Dae Seog

    2015-03-01

    The prognosis of patients with stage III/IV NK/T-cell lymphoma (NTCL) is extremely poor. Although L-asparaginase (L-asp) is effective for NTCL, its significance has not been clearly demonstrated. In addition, there are few studies comparing treatment outcomes in stage III/IV NTCL. This study evaluated the efficacy of L-asp-based chemotherapy and prognostic factors in stage III/IV NTCL. Seventy patients with newly diagnosed stage III/IV NTCL were enrolled between January 2000 and February 2013. Patients received ifosfamide, etoposide, methotrexate, and prednisolone (IMEP) plus L-asp (N?=?22) or combination chemotherapy without L-asp (N?=?48) as a first-line treatment. Clinical prognostic factors, treatment outcomes, and prognostic scores were compared between the groups. After a median follow-up period of 12.8 months (range, 1.1-186.6 months), median overall survival (OS) and progression-free survival (PFS) were 11.3 and 5.6 months, respectively. Treatment outcomes were superior in patients treated with IMEP plus L-asp compared to those treated with chemotherapy without L-asp (overall response rate, 90.0 vs. 34.8 %, P?IV NTCL, and it is an independent predictor of improved survival. PMID:25300500

  13. Covariates of intravenous paracetamol pharmacokinetics in adults

    PubMed Central

    2014-01-01

    Background Pharmacokinetic estimates for intravenous paracetamol in individual adult cohorts are different to a certain extent, and understanding the covariates of these differences may guide dose individualization. In order to assess covariate effects of intravenous paracetamol disposition in adults, pharmacokinetic data on discrete studies were pooled. Methods This pooled analysis was based on 7 studies, resulting in 2755 time-concentration observations in 189 adults (mean age 46 SD 23 years; weight 73 SD 13 kg) given intravenous paracetamol. The effects of size, age, pregnancy and other clinical settings (intensive care, high dependency, orthopaedic or abdominal surgery) on clearance and volume of distribution were explored using non-linear mixed effects models. Results Paracetamol disposition was best described using normal fat mass (NFM) with allometric scaling as a size descriptor. A three-compartment linear disposition model revealed that the population parameter estimates (between subject variability,%) were central volume (V1) 24.6 (55.5%) L/70 kg with peripheral volumes of distribution V2 23.1 (49.6%) L/70 kg and V3 30.6 (78.9%) L/70 kg. Clearance (CL) was 16.7 (24.6%) L/h/70 kg and inter-compartment clearances were Q2 67.3 (25.7%) L/h/70 kg and Q3 2.04 (71.3%) L/h/70 kg. Clearance and V2 decreased only slightly with age. Sex differences in clearance were minor and of no significance. Clearance, relative to median values, was increased during pregnancy (FPREG =?1.14) and decreased during abdominal surgery (FABDCL =?0.715). Patients undergoing orthopaedic surgery had a reduced V2 (FORTHOV =?0.649), while those in intensive care had increased V2 (FICV =?1.51). Conclusions Size and age are important covariates for paracetamol pharmacokinetics explaining approximately 40% of clearance and V2 variability. Dose individualization in adult subpopulations would achieve little benefit in the scenarios explored. PMID:25342929

  14. Contrast agent choice for intravenous coronary angiography

    NASA Astrophysics Data System (ADS)

    Zeman, H. D.; Siddons, D. P.

    1990-05-01

    The screening of the general population for coronary artery disease would be practical if a method existed for visualizing the extent of occlusion after an intravenous injection of contrast agent. Measurements performed with monochromatic synchrotron radiation X-rays and an iodine-containing contrast agent at the Stanford Synchrotron Radiation Laboratory have shown that such an intravenous angiography procedure would be possible with an adequately intense monochromatic X-ray source. Because of the size and cost of synchrotron radiation facilities it would be desirable to make the most efficient use of the intensity available, while reducing as much as possible the radiation dose experienced by the patient. By choosing contrast agents containing elements with a higher atomic number than iodine, it is possible to both improve the image quality and reduce the patient radiation dose, while using the same synchrotron radiation source. By using Si monochromator crystals with a small mosaic spread, it is possible to increase the X-ray flux available for imaging by over an order of magnitude, without any changes in the storage ring or wiggler magnet. The most critical imaging task for intravenous coronary angiography utilizing synchrotron radiation X-rays is visualizing a coronary artery through the left ventricle or aorta which also contain contrast agent. Calculations have been made of the signal to noise ratio expected for this imaging task for various contrast agents with atomic numbers between that of iodine and bismuth. The X-ray energy spectrum of the X-17 superconduction wiggler beam line at the National Synchrotron Light Source at Brookhaven National Laboratory has been used for these calculations. Both perfect Si crystals and Si crystals with a small mosaic spread are considered as monochromators. Contrast agents containing Gd or Yb seem to have about the optimal calculated signal to noise ratio. Gd-DTPA is already approved for use as a contrast agent for magnetic resonance imaging. Experiments have already been performed with Yb-DTPA in animals, and it appears to have a lower toxicity than that of Gd-DTPA. Reported animal experiments with Gd-DOTA contrast agent show no toxicity at all.

  15. The role of infection in the morbidity and mortality of patients with head and neck cancer undergoing multimodality therapy.

    PubMed

    Hussain, M; Kish, J A; Crane, L; Uwayda, A; Cummings, G; Ensley, J F; Tapazoglou, E; al-Sarraf, M

    1991-02-01

    Cancer of the head and neck is a common cancer worldwide. The majority of patients present with locally advanced disease. Recently a great deal of improvement has been made in multimodality therapy of this disease, warranting more careful consideration of factors affecting quality of life, disease course, and treatment. Infection is clearly a factor. Analysis of 662 hospital admissions of 169 head and neck cancer patients was performed. A definite infection was documented in 86 febrile episodes, pneumonia contributed to 40%, bacteremia to 13%, skin and soft tissue infection to 12%, and tracheobronchitis to 10%. Among the evaluated risk factors, foreign bodies, specifically intravenous (IV) cannulae and gastrostomy tubes, race, performance status, alcohol intake, and nutritional status were statistically significant variables that predicted for or were associated with infection. Infection contributed to 44% of the deaths. PMID:1985764

  16. Fatal kavalactone intoxication by suicidal intravenous injection.

    PubMed

    Ketola, Raimo A; Viinamäki, Jenni; Rasanen, Ilpo; Pelander, Anna; Goebeler, Sirkka

    2015-04-01

    Kavalactones are a group of compounds found in kava, a beverage or extract prepared from the rhizome of the kava plant (Piper methysticum). Traditionally kava extracts have been used for their anxiolytic and sedative properties. Sales of kava extracts were severely restricted or prohibited in European countries in 2002 following several cases of serious hepatotoxicity. Here we report a case where high concentrations of kavalactones and ethanol were detected in post mortem femoral blood. An injection needle with a 10-mL syringe containing 7.5mL of slightly yellowish liquid was found next to the victim, and there were numerous needle prints on both lower arms following the venous tracks. No evidence of other cause of death was found in the medico-legal investigation. The case was therefore classified as suicide using an injection of kavalactones intravenously together with alcohol poisoning. PMID:25684328

  17. Intravenous regional analgesia--a new modification.

    PubMed

    Cox, P

    1989-05-01

    A modification of the standard intravenous regional analgesia technique is described whereby excess local anaesthetic solution is removed from the veins of the isolated arm once analgesia has been established. This simple procedure was shown to reduce the incidence of oozing at the site of operation without affecting the quality of analgesia. Measurement of the quantity of local anaesthetic agent removed from the isolated arm 15 min after injection revealed that the amounts removed were small, indicating rapid uptake and binding in the tissues. This would imply that removal of excess local anaesthetic agent from the isolated arm after 15 min does not confer added safety as regards reducing the risk of leakage of agent into the general circulation in the event of cuff failure. PMID:2655367

  18. Intravenous Iron Sucrose and Oral Iron for the Treatment of Iron Deficiency Anaemia in Pregnancy

    PubMed Central

    Abhilashini, G.D.; Reddi, Rani

    2014-01-01

    Purpose: The aim of this study was to compare the efficacy and safety of intravenous iron sucrose and oral iron administration for the treatment of iron deficiency anaemia in pregnancy. Materials and Methods: Hundred women with gestational age between 30 and 34 weeks with established iron deficiency anaemia with Haemoglobin-6-8g/dL were randomised to receive either oral ferrous sulphate 200 mg thrice daily or required dose of intravenous iron sucrose 200 mg in 200 ml NS on alternate days. Haemoglobin, haematocrit, mean corpuscular volume, reticulocyte count were measured at recruitment and on 2nd week, 4th week and at 37 weeks. Adverse drug reactions were also noted in both the groups. Results were analyzed by student’s t-test and Chi-square test. Results: Haemoglobin values varied significantly with time between the two groups at second week, 4th week and at term (p<0.005). The mean difference in mean corpuscular volume from the recruitment value was not significant at 2nd week. When compared to iron sucrose group, oral iron group had significant gastro-intestinal adverse effects. Conclusion: Intravenous iron sucrose treated iron deficiency anaemia of pregnancy faster, and more effectively than oral iron therapy, with no serious adverse drug reactions. PMID:24995217

  19. Is intravenous iron sucrose the treatment of choice for pregnant anemic women?

    PubMed

    Devasenapathy, Niveditha; Neogi, Sutapa Bandyopadhyay; Zodpey, Sanjay

    2013-03-01

    Anemia during pregnancy remains an important public health problem in developing countries like India. Anemia is the direct cause of 12-15% of maternal deaths. Iron deficiency is the commonest cause for anemia in the Indian subcontinent. Several preventive and therapeutic approaches are in practice. The available routes of iron supplementation are oral and intravenous. In spite of oral iron being least invasive, cheap and safe, the ineffectiveness of oral iron due to dietary inhibitors and poor compliance are well known. Intravenous iron sucrose can be a promising therapy for moderate to severely anemic pregnant women and has been in practice for quite some time in private and public health practices. In this article, we report the current evidence on the safety and efficacy of intravenous iron sucrose in anemic pregnant women on hematological and clinical outcomes. Though the evidence on its efficacy in improving hemoglobin and serum ferritin is convincing, its effect on maternal and fetal outcomes are unclear. This is primarily due to lack of well-designed and larger studies powered to detect difference in clinical outcomes. Hence, there is a need to gather evidence from a well-designed large randomized clinical trial conducted in a developing country. The results of such a study would feed into the national policy and would form the basis to frame guidelines for management of anemia in developing countries. PMID:23167561

  20. Implant surgery for a patient with Parkinson's disease controlled by intravenous midazolam: a case report.

    PubMed

    Kubo, Keiji; Kimura, Kayo

    2004-01-01

    A 72-year-old male patient with Parkinson's disease referred to the Dental Hospital of Kyushu University, Fukuoka, Japan, presented with movement of an implant-supported prosthesis, slight pain, and purulent drainage from the gingiva in the anterior region of the maxilla, where implants had been placed more than 20 years earlier. He requested that the mobile implant and prosthesis be removed and was in need of implant therapy in his maxilla. In addition to Parkinson's disease the patient had a severe gag reflex, which made treatment difficult. A total of 6 treatments were required. New implants were successfully placed while the patient was under anesthesia (a combination of intravenously administered 3% prilocaine hydrochloride and vasopressin); midazolam was also administered intravenously. The results of this case indicate that use of regional anesthesia in combination with midazolam can be recommended for implant surgery in patients with Parkinson's disease. Intravenous midazolam can be considered the sedative of choice for the surgical treatment of patients suffering from systemic disease. PMID:15101602

  1. Correction of ? 654 -thalassaemia mice using direct intravenous injection of siRNA and antisense RNA vectors

    Microsoft Academic Search

    Shu-Yang XieWei; Wei Li; Zhao-Rui Ren; Shu-Zhen Huang; Fanyi Zeng; Yi-Tao Zeng

    2011-01-01

    Although the therapeutic efficacy of ?654-thalassaemia treatment using a combination of RNAi and antisense RNA to balance the synthesis of ?- and ?-globin chains has\\u000a been demonstrated previously, and the safety of lentiviral delivery remains unclear. Herein, we used the same ?654-thalassaemia mouse model to develop a therapy involving direct delivery of siRNA and antisense RNA plasmids via intravenous\\u000a injection

  2. Pharmacokinetics and safety of voriconazole intravenous-to-oral switch regimens in immunocompromised Japanese pediatric patients.

    PubMed

    Mori, Masaaki; Kobayashi, Ryoji; Kato, Koji; Maeda, Naoko; Fukushima, Keitaro; Goto, Hiroaki; Inoue, Masami; Muto, Chieko; Okayama, Akifumi; Watanabe, Kenichi; Liu, Ping

    2015-02-01

    The aim of this study was to investigate the pharmacokinetics, safety, and tolerability of voriconazole following intravenous-to-oral switch regimens used with immunocompromised Japanese pediatric subjects (age 2 to <15 years) at high risk for systemic fungal infection. Twenty-one patients received intravenous-to-oral switch regimens based on a recent population pharmacokinetic modeling; they were given 9 mg/kg of body weight followed by 8 mg/kg of intravenous (i.v.) voriconazole every 12 h (q12h), and 9 mg/kg (maximum, 350 mg) of oral voriconazole q12h (for patients age 2 to <12 or 12 to <15 years and <50 kg) or 6 mg/kg followed by 4 mg/kg of i.v. voriconazole q12h and 200 mg of oral voriconazole q12h (for patients age 12 to <15 years and ?50 kg). The steady-state area under the curve over the 12-h dosing interval (AUC0-12,ss) was calculated using the noncompartmental method and compared with the predicted exposures in Western pediatric subjects based on the abovementioned modeling. The geometric mean (coefficient of variation) AUC0-12,ss values for the intravenous and oral regimens were 51.1 ?g · h/ml (68%) and 45.8 ?g·h/ml (90%), respectively; there was a high correlation between AUC0-12,ss and trough concentration. Although the average exposures were higher in the Japanese patients than those in the Western pediatric subjects, the overall voriconazole exposures were comparable between these two groups due to large interindividual variability. The exposures in the 2 cytochrome P450 2C19 poor metabolizers were among the highest. Voriconazole was well tolerated. The most common treatment-related adverse events were photophobia and abnormal hepatic function. These recommended doses derived from the modeling appear to be appropriate for Japanese pediatric patients, showing no additional safety risks compared to those with adult patients. (This study has been registered at ClinicalTrials.gov under registration no. NCT01383993.). PMID:25451051

  3. Cystic fibrosis: cost of illness and considerations for the economic evaluation of potential therapies.

    PubMed

    Krauth, Christian; Jalilvand, Noushin; Welte, Tobias; Busse, Reinhard

    2003-01-01

    Cystic fibrosis (CF) is the most common life-shortening inherited disease of the Caucasian race, with a prevalence of around 1 in 2500 live births. Advances in the treatment and management of respiratory and pancreatic disorders have dramatically increased the life expectancy of patients with CF. This article presents an overview of cost-of-illness studies of CF, identifies deficits in the available health economic analyses of CF and discusses which specific factors are essential for the economic evaluation of potential therapies, based on a critical review of the health economic literature on two main therapeutic strategies. Cost-of-illness studies of CF have predominantly been restricted to direct costs. According to the literature, direct costs amount to between 6200- 16300 US dollars (1996 values) per patient per year. As most studies likely underestimated the actual costs (e.g. by disregarding provision of certain healthcare services), real healthcare costs tend to be at the upper end of the cost range. Healthcare costs depend on the patient's age (for adults, costs are approximately twice as high as for children), the grade of severity (the cost relationship of severe to mild CF is between 4.5 and 7.1) and other factors. Lifetime direct costs of CF are estimated at 200 000-300000 US dollars (at 1996 values and a discount rate of 5%). Home intravenous (IV) antibacterial therapy and recombinant human DNase (rhDNase; dornase alfa) treatment are the two main therapeutic strategies most often evaluated in health economic studies of CF. While home IV antibacterial therapy (compared with inpatient IV antibacterial therapy) is assumed to be cost saving, rhDNase treatment is a very cost-intensive therapy intended to efficiently achieve health improvements. Health economic analyses of future CF therapeutic technologies should present explicit data regarding healthcare services provision, resource consumption and unit costs. Indirect costs and patient costs should be considered more often than they have to date, particularly when they are significantly influenced by novel CF technologies. The perspective of health economic studies should be stated explicitly and always include the societal perspective. More economic studies should be based on a controlled, and preferably randomised, design. The observation period must be long enough to identify long-term effects of interventions. A greater number of effectiveness studies should be performed to determine costs and outcomes of therapies applied under everyday life conditions for patients with CF. Finally, international comparison studies should identify the influence of different healthcare systems on the costs and outcomes of interventions. PMID:13129414

  4. Clorsulon pharmacokinetics in sheep and goats following oral and intravenous administration.

    PubMed

    Sundlof, S F; Whitlock, T W

    1992-09-01

    Clorsulon was measured in plasma and urine of sheep and goats after administration of a single intravenous (i.v.) and after a single oral dose of 7 mg/kg. A three-compartment model with elimination occurring from the central compartment was determined to best describe the i.v. data, whereas a one-compartment model with a single exponential absorption phase best described the oral plasma data. The bioavailability of orally administered clorsulon was approximately 55% in goats and 60% in sheep. Peak plasma concentrations occurred at 14 h and 15 h after oral administration in goats and sheep, respectively. Absorption from the gastro-intestinal tract effectively prolonged the elimination of clorsulon by increasing the elimination half-life from 17 to 28 h in sheep and from 12 to 23 h in goats for the i.v. and oral routes, respectively. In both goats and sheep, approximately 50% of the i.v. dose was recovered in urine as parent drug at 48 h after administration, whereas 41% and 30% of the dose was recovered after oral administration for goats and sheep, respectively. The elimination rate constant (kel) in goats was nearly twice as large as the value determined in sheep, and the urea under the i.v. plasma curve in goats was only 63% of the value in sheep indicating that goats are more effective in their capacity to eliminate clorsulon than are sheep. These differences in drug disposition between sheep and goats may account for the reduced efficacy of clorsulon reported in goats. PMID:1433492

  5. The potential for neurovascular intravenous angiography using K-edge digital subtraction angiography

    NASA Astrophysics Data System (ADS)

    Schültke, E.; Fiedler, S.; Kelly, M.; Griebel, R.; Juurlink, B.; LeDuc, G.; Estève, F.; Le Bas, J.-F.; Renier, M.; Nemoz, C.; Meguro, K.

    2005-08-01

    Background: Catheterization of small-caliber blood vessels in the central nervous system can be extremely challenging. Alternatively, intravenous (i.v.) administration of contrast agent is minimally invasive and therefore carries a much lower risk for the patient. With conventional X-ray equipment, volumes of contrast agent that could be safely administered to the patient do not allow acquisition of high-quality images after i.v. injection, because the contrast bolus is extremely diluted by passage through the heart. However, synchrotron-based digital K-edge subtraction angiography does allow acquisition of high-quality images after i.v. administration of relatively small doses of contrast agent. Materials and methods: Eight adult male New Zealand rabbits were used for our experiments. Animals were submitted to both angiography with conventional X-ray equipment and synchrotron-based digital subtraction angiography. Results: With conventional X-ray equipment, no contrast was seen in either cerebral or spinal blood vessels after i.v. injection of iodinated contrast agent. However, using K-edge digital subtraction angiography, as little as 1 ml iodinated contrast agent, when administered as i.v. bolus, yielded images of small-caliber blood vessels in the central nervous system (both brain and spinal cord). Conclusions: If it would be possible to image blood vessels of the same diameter in the central nervous system of human patients, the synchrotron-based technique could yield high-quality images at a significantly lower risk for the patient than conventional X-ray imaging. Images could be acquired where catheterization of feeding blood vessels has proven impossible.

  6. Effect of different intravenous iron preparations on lymphocyte intracellular reactive oxygen species generation and subpopulation survival

    PubMed Central

    2010-01-01

    Background Infections in hemodialysis (HD) patients lead to high morbidity and mortality rates and are associated with early cardiovascular mortality, possibly related to chronic inflammation. Intravenous (IV) iron is widely administered to HD patients and has been associated with increased oxidative stress and dysfunctional cellular immunity. The purpose of this study was to examine the effect of three commercially available IV iron preparations on intracellular reactive oxygen species generation and lymphocyte subpopulation survival. Methods Peripheral blood mononuclear cells (PBMC) were isolated from healthy donor buffy coat. PBMC were cultured and incubated with 100 ?g/mL of sodium ferric gluconate (SFG), iron sucrose (IS) or iron dextran (ID) for 24 hours. Cells were then probed for reactive oxygen species (ROS) with dichlorofluorescein-diacetate. In separate studies, isolated PBMCs were incubated with the 25, 50 or 100 ?g/mL iron concentrations for 72 hours and then stained with fluorescein conjugated monoclonal antibodies for lymphocyte subpopulation identification. Untreated PBMCs at 24 hours and 72 hours served as controls for each experiment. Results All three IV iron preparations induced time dependent increases in intracellular ROS with SFG and IS having a greater maximal effect than ID. The CD4+ lymphocytes were most affected by IV iron exposure, with statistically significant reduction in survival after incubation with all three doses (10, 25 and 100 ?g/mL) of SFG, IS and ID. Conclusion These data indicate IV iron products induce differential deleterious effects on CD4+ and CD16+ human lymphocytes cell populations that may be mediated by intracellular reactive oxygen species generation. Further studies are warranted to determine the potential clinical relevance of these findings. PMID:20716362

  7. Minimum intravenous infectious dose of ovine progressive pneumonia virus (OPPV)

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The minimum intravenous infectious dose for ovine progressive pneumonia virus (OPPV) WLC1 was determined using twenty-four 6 month-old lambs. Twelve groups of two 6 month-old lambs were inoculated intravenously with tissue culture fluid containing ovine progressive pneumonia virus (OPPV) WLC1 titer...

  8. Tibial bone harvesting under intravenous sedation: Morbidity and patient experiences

    Microsoft Academic Search

    Jose M. Marchena; Michael S. Block; John D. Stover

    2002-01-01

    Purpose: The aims of this study were to evaluate the complication rate, the recovery, and the experience in patients undergoing tibial bone harvesting under intravenous sedation. Patients and Methods: This was a prospective study of 10 consecutive patients who underwent unilateral or bilateral sinus grafting with tibial bone grafts under intravenous sedation in a 3-month period in the oral and

  9. Intravenous morphine pharmacokinetics in pediatric patients with sickle cell disease

    Microsoft Academic Search

    Carlton D. Dampier; B. N. Y. Setty; Joann Logan; Jacqueline G. Ioli; Roger Dean

    1995-01-01

    To examine the pharmacokinetics of parenteral opioids, such as morphine, in patients with sickle cell disease, we determined the plasma morphine clearances in 18 patients (aged 6 to 19 years) who were receiving continuous intravenous infusions, and the pharmacokinetics of morphine in an additional six patients after single intravenous doses. Plasma morphine clearances ranged from 6.2 to 59.1 ml min-

  10. Aluminum removal by peritoneal dialysis: Intravenous vs. intraperitoneal deferoxamine

    Microsoft Academic Search

    Gavril Hercz; Isidro B Salusky; Keith C Norris; Richard N Fine; Jack W Coburn

    1986-01-01

    Aluminum removal by peritoneal dialysis: Intravenous vs. intraperitoneal deferoxamine. Aluminum removal via peritoneal dialysis was evaluated after the administration of deferoxamine in patients treated with CAPD and CCPD. The intravenous administration of deferoxamine, 40 mg\\/kg, led to a 730 ± 139% increase in aluminum removal, compared to an increase of 641 ± 178% after the drug was administered intraperitoneally. The

  11. Rectovaginal fistula: management by intravenous feeding and surgical repair.

    PubMed

    Piraka, H; Parsa, M H; Jahanmiri, F

    Two patients, each with a large rectovaginal fistula, were managed successfully by intravenous feeding and surgical repair of their fistulae. Intravenous feeding eliminated the need for food from the gastrointestinal tract, thus minimizing the fecal flow. Both fistulae healed following surgical repair. Neither patient required a diverting colostomy. PMID:32102

  12. High-dose intravenous gammaglobulin for chronic inflammatory demyelinating polyneuropathy

    Microsoft Academic Search

    B. Currò Dossi; F. Tezzon

    1987-01-01

    We report our preliminary experience of high-dose intravenous gammaglobulin in patients with chronic inflammatory demyelinating polyneuropathy (CIDP) selected for inefficacy or severe side effects of steroid and immunosuppressive treatment. Our treatment proved safe and effective, reversing the disability of CIDP, the improvement being temporally related to the commencement of intravenous high-dose gammaglobulin. The possible mechanisms of action are discussed.

  13. A pilot study of intravenous ondansetron for hyperemesis gravidarum

    Microsoft Academic Search

    Christopher A. Sullivan; Cheryl A. Johnson; Holli Roach; Rick W. Martin; Deanna K. Stewart; John C. Morrison

    1996-01-01

    OBJECTIVE: We attempted to determine whether the antiemetic ondansetron would be more effective than promethazine in treating hyperemesis gravidarum. STUDY DESIGN: Patients with hyperemesis gravidarum who required hospital admission were randomized to receive either intravenous ondansetron (n = 15) or intravenous promethazine (n = 15) in a double-blind manner. Severity of disease was determined by electrolyte status, weight loss, ketonuria,

  14. Ethnographic study of incidence and severity of intravenous drug errors

    Microsoft Academic Search

    Katja Taxis

    2003-01-01

    Objectives To determine the incidence and clinical importance of errors in the preparation and administration of intravenous drugs and the stages of the process in which errors occur. Design Prospective ethnographic study using disguised observation. Participants Nurses who prepared and administered intravenous drugs. Setting 10 wards in a teaching and non-teaching hospital in the United Kingdom. Main outcome measures Number,

  15. Clinical experience with intravenous misonidazole for carcinoma of the esophagus: results in attempting radiosensitization of each fraction of exposure

    SciTech Connect

    Schwade, J.G.; Kinsella, T.J.; Kelly, B.; Rowland, J.; Johnston, M.; Glatstein, E.

    1984-01-01

    By using intravenous misonidazole, a hypoxic cell radiosensitizer, the authors attempted to test the hypothesis of hypoxia as the basis of the relatively poor results seen with radiation therapy in the treatment of carcinoma of the thoracic esophagus. As the peripheral neuropathy of misonidazole was well recognized, they felt that an adequate dose of misonidazole could be given approximately ten times before peripheral neuropathy would necessitate its discontinuation. Because of a desire to maximize any possible effects of radiosensitization, it was decided to administer misonidazole with each fraction of radiation, attempting to deliver curative radiation therapy with only ten fractions of radiation. The authors thus devised a scheme of radiation consisting of 400 rad twice a week for 5 weeks, a total of 4000 rad. Originally the attempt was made to utilize preoperative radiation therapy and assess the histologic specimens for efficacy. However, major pulmonary toxicity caused revision of that plan. Twenty six patients were treated with radiotherapy alone without surgery, 12 of the patients being randomized to receive intravenous misonidazole with 10 fractions of 400 rad each. In terms of partial response, complete response, local control, and long-term survival, there was no suggestion of any benefit of intravenous misonidazole in these patients. As a consequence, although the number of study patients was small, the investigation was discontinued. Possible explanations for the failure to demonstrate any benefit of misonidazole are discussed.

  16. Intravenous transplantation of bone marrow-derived mononuclear cells prevents memory impairment in transgenic mouse models of Alzheimer's disease.

    PubMed

    Kanamaru, Takuya; Kamimura, Naomi; Yokota, Takashi; Nishimaki, Kiyomi; Iuchi, Katsuya; Lee, Hyunjin; Takami, Shinya; Akashiba, Hiroki; Shitaka, Yoshitsugu; Ueda, Masayuki; Katsura, Ken-Ichiro; Kimura, Kazumi; Ohta, Shigeo

    2015-04-24

    Stem cell transplantation therapy is currently in clinical trials for the treatment of ischemic stroke, and several beneficial aspects have been reported. Similarly, in Alzheimer's disease (AD), stem cell therapy is expected to provide an efficient therapeutic approach. Indeed, the intracerebral transplantation of stem cells reduced amyloid-? (A?) deposition and rescued memory deficits in AD model mice. Here, we show that intravenous transplantation of bone marrow-derived mononuclear cells (BMMCs) improves cognitive function in two different AD mouse models, DAL and APP mice, and prevents neurodegeneration. GFP-positive BMMCs were isolated from tibiae and femurs of 4-week-old mice and then transplanted intravenously into DAL and APP mice. Transplantation of BMMCs suppressed neuronal loss and restored memory impairment of DAL mice to almost the same level as in wild-type mice. Transplantation of BMMCs to APP mice reduced A? deposition in the brain. APP mice treated with BMMCs performed significantly better on behavioral tests than vehicle-injected mice. Moreover, the effects were observed even with transplantation after the onset of cognitive impairment in DAL mice. Together, our results indicate that intravenous transplantation of BMMCs has preventive effects against the cognitive decline in AD model mice and suggest a potential therapeutic effect of BMMC transplantation therapy. PMID:25698614

  17. Immune tolerance induction in patients with IgA anaphylactoid reactions following long-term intravenous IgG treatment

    PubMed Central

    Ahrens, N; Höflich, C; Bombard, S; Lochs, H; Kiesewetter, H; Salama, A

    2008-01-01

    To date, there is very little information regarding the pathomechanism of IgA anaphylactoid reactions and the management of affected patients. Five adult patients with common variable immunodeficiency (CVID) and a history of anaphylactic reactions due to the administration of immunoglobulin preparations were studied. The activity of anti-IgA was determined by the gel agglutination technique using IgA-coated beads. Antibodies to IgA were detected in the serum of all five patients. Initially, IgA ‘depleted’ intravenous (i.v.) IgG preparations were infused carefully into the patients until the activity of anti-IgA was decreased significantly or became undetectable. Subsequently, unselected i.v. IgG preparations were infused, and the activity of anti-IgA was abolished in all cases. Intravenous IgG long-term administration results in tolerance induction in patients with IgA anaphylactoid reactions. This tolerance appears to be related to antibody blockage in the circulation and an inhibition of antibody production. Most importantly, IgA appears to play an important role in the treatment of CVID. Patients with IgA anaphylactoid reactions can be treated safely with IgA containing i.v. IgG preparations following tolerance induction. PMID:18234056

  18. Energy expenditure by intravenous administration of glucagon-like peptide-1 mediated by the lower brainstem and sympathoadrenal system.

    PubMed

    Osaka, Toshimasa; Endo, Mari; Yamakawa, Midori; Inoue, Shuji

    2005-09-01

    Glucagon-like peptide-1 (GLP-1) is released from the gut in response to nutrient ingestion. Intravenous (iv) administration of GLP-1 (50 pmol-20 nmol) elicited dose-dependent increases in the rate of whole-body O2 consumption (VO2), an index of energy expenditure, and heart rate of urethane-anesthetized rats. The body core (colonic) temperature increased up to 0.3 degrees C without accompanying alteration of tail skin temperature. Intracerebroventricular (icv) administration of GLP-1 induced a slower and smaller increase in VO2 than the intravenous administration. The injection of glucagon-like peptide-2 (iv or icv) had no effect on VO2, body temperatures, or heart rate. Decerebration had no effect on the thermogenic responses induced by the iv administration of GLP-1, suggesting that the forebrain is not essential for these responses. However, cervical spinal transection greatly attenuated the responses, suggesting the critical involvement of the lower brainstem. Adrenalectomy or pretreatment with an autonomic ganglion blocker, hexamethonium, or a beta-adrenergic blocker, propranolol, also significantly attenuated the thermogenic response. However, subdiaphragmatic vagotomy or celiac-superior mesenteric ganglionectomy had no effect. Rats made insulin-deficient by pretreatment with streptozotocin also exhibited the normal thermogenic response to GLP-1. These results suggest the involvement of the GLP-1 in postprandial energy expenditure, mediated by the lower brainstem and sympathoadrenal system. PMID:16112402

  19. Intravenous Fluid Mixing in Normal Gravity, Partial Gravity, and Microgravity: Down-Selection of Mixing Methods

    NASA Technical Reports Server (NTRS)

    Niederhaus, Charles E.; Miller, Fletcher J.

    2008-01-01

    The missions envisioned under the Vision for Space Exploration will require development of new methods to handle crew medical care. Medications and intravenous (IV) fluids have been identified as one area needing development. Storing certain medications and solutions as powders or concentrates can both increase the shelf life and reduce the overall mass and volume of medical supplies. The powders or concentrates would then be mixed in an IV bag with Sterile Water for Injection produced in situ from the potable water supply. Fluid handling in microgravity is different than terrestrial settings, and requires special consideration in the design of equipment. This document describes the analyses and down-select activities used to identify the IV mixing method to be developed that is suitable for ISS and exploration missions. The chosen method is compatible with both normal gravity and microgravity, maintains sterility of the solution, and has low mass and power requirements. The method will undergo further development, including reduced gravity aircraft experiments and computations, in order to fully develop the mixing method and associated operational parameters.

  20. Roux-en-Y Gastric Bypass Increases Intravenous Ethanol Self-Administration in Dietary Obese Rats

    PubMed Central

    Polston, James E.; Pritchett, Carolyn E.; Tomasko, Jonathan M.; Rogers, Ann M.; Leggio, Lorenzo; Thanos, Panayotis K.; Volkow, Nora D.; Hajnal, Andras

    2013-01-01

    Roux-en-Y gastric bypass surgery (RYGB) is an effective treatment for severe obesity. Clinical studies however have reported susceptibility to increased alcohol use after RYGB, and preclinical studies have shown increased alcohol intake in obese rats after RYGB. This could reflect a direct enhancement of alcohol’s rewarding effects in the brain or an indirect effect due to increased alcohol absorption after RGYB. To rule out the contribution that changes in alcohol absorption have on its rewarding effects, here we assessed the effects of RYGB on intravenously (IV) administered ethanol (1%). For this purpose, high fat (60% kcal from fat) diet-induced obese male Sprague Dawley rats were tested ?2 months after RYGB or sham surgery (SHAM) using both fixed and progressive ratio schedules of reinforcement to evaluate if RGYB modified the reinforcing effects of IV ethanol. Compared to SHAM, RYGB rats made significantly more active spout responses to earn IV ethanol during the fixed ratio schedule, and achieved higher breakpoints during the progressive ratio schedule. Although additional studies are needed, our results provide preliminary evidence that RYGB increases the rewarding effects of alcohol independent of its effects on alcohol absorption. PMID:24391816

  1. Pharmacokinetics of meloxicam in mature swine after intravenous and oral administration.

    PubMed

    Pairis-Garcia, M D; Johnson, A K; Kukanich, B; Wulf, L; Millman, S T; Stalder, K J; Karriker, L A; Coetzee, J F

    2014-10-01

    The purpose of this study was to compare the pharmacokinetics of meloxicam in mature swine after intravenous (i.v.) and oral (p.o.) administration. Six mature sows (mean bodyweight ± standard deviation = 217.3 ± 65.68 kg) were administered an i.v. or p.o. dose of meloxicam at a target dose of 0.5 mg/kg in a cross-over design. Plasma samples collected up to 48 h postadministration were analyzed by high-pressure liquid chromatography and mass spectrometry (HPLC-MS) followed by noncompartmental pharmacokinetic analysis. Mean peak plasma concentration (CMAX ) after p.o. administration was 1070 ng/mL (645-1749 ng/mL). TMAX was recorded at 2.40 h (0.50-12.00 h) after p.o. administration. Half-life (T½ ?z ) for i.v. and p.o. administration was 6.15 h (4.39-7.79 h) and 6.83 h (5.18-9.63 h), respectively. The bioavailability (F) for p.o. administration was 87% (39-351%). The results of this study suggest that meloxicam is well absorbed after oral administration. PMID:25269447

  2. Pharmacokinetics of marbofloxacin after intravenous and intramuscular administration in Hanwoo, Korean native cattle

    PubMed Central

    BELEW, Sileshi; KIM, Jin-Yoon; HOSSAIN, Md.Akil; PARK, Ji-Yong; LEE, Seung-Jin; PARK, Yong-Soo; SUH, Joo-Won; KIM, Jong-Choon; PARK, Seung-Chun

    2014-01-01

    Pharmacokinetic (PK) parameters of marbofloxacin (MRFX) in Korean cattle, Hanwoo, were determined following its intravenous (i.v.) or intramuscular (i.m.) administration at a dose of 2 mg/kg. Area under the curve (AUC0–24 hr), half-life (t1/2) and total body clearance (CLB) of i.v. MRFX were 6.87 hr?µg/ml, 2.44 hr and 0.29 l/kg?hr, respectively, and the corresponding values for i.m. administration of MRFX were 5.07 hr?µg/ml, 2.44 hr and 0.39 l/kg?hr. The suggested optimal doses of MRFX in Hanwoo cattle, calculated by integration of PK data obtained in the present study and previously reported minimum inhibitory concentration (MIC) for MRFX against susceptible (MIC ?1 µg/ml) and intermediate (MIC ?2 µg/ml) pathogenic bacteria, were 2.1 and 4.2 mg/kg/day by i.v. route and 3.9 and 7.8 mg/kg/day by i.m. route. PMID:25411109

  3. S-1 plus intravenous and intraperitoneal Paclitaxel for gastric cancer with peritoneal metastasis.

    PubMed

    Kitayama, Joji; Ishigami, Hironori; Yamaguchi, Hironori; Yamashita, Hiroharu; Emoto, Shigenobu; Kaisaki, Shoichi

    2012-05-01

    Peritoneal metastasis is the most frequent and life-threatening type of metastasis in patients with advanced gastric cancer. Despite recent advances in chemotherapeutic agents, any treatment, if administered only via the intravenous (IV) route, cannot satisfactorily control peritoneal metastasis in gastric cancer. Although intraperitoneal (IP) chemotherapy has been proposed as a treatment option, the clinical efficacy of IP chemotherapy for peritoneal lesions has not been examined in gastrointestinal cancer. One hundred patients with gastric cancer received combination chemotherapy of S-1 plus IV (50 mg/m(2)) and IP (20 mg/m(2)) paclitaxel (PTX) via a subcutaneously implanted peritoneal access port. S-1 was administered at 80 mg/m(2) per day for 14 consecutive days, followed by 7 days' rest. Radical gastrectomy was performed in a salvage setting when macroscopic curative resection was made feasible by the downstaging achieved by the combined chemotherapy. The median survival time (MST) of the patient sample was 23.6 months, with a 1-year survival of 80%. Combination chemotherapy of S-1 plus IV and IP PTX is well tolerated and very effective in patients with gastric cancer and peritoneal metastasis. Systemic chemotherapy combined with repeated IP administration of paclitaxel is a promising strategy for peritoneal carcinomatosis in gastrointestinal cancer. PMID:22876333

  4. Failure of intravenous pentagastrin challenge to induce panic-like effects in rhesus monkeys.

    PubMed

    Rupniak, N M; Schaffer, L; Siegl, P; Iversen, S D

    1993-08-01

    We examined the ability of intravenous (i.v.) challenge with pentagastrin to induce behavioural and cardiovascular effects consistent with panic attack in conscious rhesus monkeys. For behavioural evaluation, 4 naive male rhesus monkeys familiar with minimal manual restraint necessary for drug administration received a rapid i.v. bolus of pentagastrin (4, 8 or 16 micrograms/kg) or water on four separate occasions according to a randomised cross-over design. Behaviour was rated by a blind observer continuously during, and for the first 5 min immediately following i.v. injections while the monkey sat on the handler's lap, and then for a further 25 min in an individual observation cage. In separate experiments, the ability of pentagastrin to alter cardiovascular parameters which may accompany panic or anxiety (elevated heart rate and blood pressure) was explored. For cardiovascular studies, 8 male or female rhesus monkeys with femoral artery catheters were chair restrained and received a bolus injection of pentagastrin (4, 8 or 16 micrograms/kg) or saline into the saphenous vein at 30 min intervals. Blood pressure and heart rate were monitored continuously using a Statham Gould pressure transducer. Pentagastrin induced no consistent behavioural or cardiovascular changes. Similar pilot studies using CCK4 also failed to reveal such effects. We conclude that CCK-induced panic-like effects may not be demonstrable following challenge with pentagastrin under laboratory conditions in rhesus monkeys. PMID:8413856

  5. Intravenous liposomal benznidazole as trypanocidal agent: increasing drug delivery to liver is not enough.

    PubMed

    Morilla, M J; Montanari, J A; Prieto, M J; Lopez, M O; Petray, P B; Romero, E L

    2004-07-01

    With the aim of investigating if delivery of benznidazole (BNZ) to liver could be increased by incorporating the drug in multilamellar liposomes, single bolus of free BNZ or liposomal BNZ formulations (MLV-BNZ) composed of HSPC:DSPG:Chol 2:1:2 (mol/mol/mol) at 0.7% (w/w) drug/total lipid ratio, were injected by intramuscular (i.m.), subcutaneous (s.c.) and intravenous (i.v.) routes, at 0.2 mg BNZ/kg, in rats. The resulting blood concentrations were followed along 9 h post-injection (p.i.) and drug accumulation in liver was determined after 4 and 9 h p.i. Only upon i.v. injection of MLV-BNZ, a threefold higher BNZ accumulation in liver was obtained, together with blood BNZ concentrations of 1.1 microg/ml (30% lower than the blood BNZ concentration achieved upon i.v. administration of free drug) occurred 4 h p.i. However, such increased liver uptake of BNZ, raised twice a week had no effect on parasitaemia levels of mice infected with the RA strain of Trypanosoma cruzi. Our results indicate that the relationship between increased selectivity for an infected tissue and therapeutic effect is not always straightforward, at least for the MLV-BNZ regimen used in the present study. PMID:15196636

  6. Globotriaosylsphingosine (lyso-Gb3) might not be a reliable marker for monitoring the long-term therapeutic outcomes of enzyme replacement therapy for late-onset Fabry patients with the Chinese hotspot mutation (IVS4+919G>A)

    PubMed Central

    2014-01-01

    Background In Taiwan, DNA-based newborn screening showed a surprisingly high incidence (1/875 in males and 1/399 in females) of a cardiac Fabry mutation (IVS4?+?919G?>?A). However, the natural course, long-term treatment outcomes and suitable biomarkers for monitoring the therapeutic outcomes of these patients are largely unknown. Methods Fabry disease (FD) patients who had received enzyme replacement therapy (ERT) for more than 1 year were enrolled in this study from December 2008 to April 2013. Periodic echocardiography and serum globotriaosylsphingosine (lyso-Gb3) analysis were carried out. Before and after ERT, left ventricular mass index (LVMI) and serum lyso-Gb3 level were compared and the correlation between the change of LVMI and the change of serum lyso-Gb3 were also analyzed. Results Thirty-six patients, in four patient groups, were enrolled: (1) 16 males with IVS4?+?919G?>?A mutation; (2) 7 females with IVS4?+?919G?>?A mutation; (3) 2 males with classical mutations; and (4) 11 females with classical mutations. The follow-up period was 13–46 months. There were significant LVMI reductions after ERT in all four groups after excluding confounding factors. However, interestingly, serum lyso-Gb3 decreased significantly in the early period after ERT in all groups, but increased gradually after an average of 11.1 months after ERT in late-onset male and female Fabry groups, even when their LVMI still decreased or remained stable. Furthermore, there was no correlation between the change of serum lyso-Gb3 and the change of LVMI in both classical and IVS4?+?919G?>?A FD patients. Conclusion Although lyso-Gb3 has a high diagnostic sensitivity in late-onset Fabry patients and has a good response to ERT during the early stages, it might not be a reliable marker for monitoring the long-term therapeutic outcomes of ERT for late-onset Fabry patients with the Chinese hotspot mutation (IVS4?+?919G?>?A). PMID:25047006

  7. Intravenous dexamethasone versus ketamine gargle versus intravenous dexamethasone combined with ketamine gargle for evaluation of post-operative sore throat and hoarseness: A randomized, placebo-controlled, double blind clinical trial

    PubMed Central

    Safavi, Mohammadreza; Honarmand, Azim; Fariborzifar, Arghavan; Attari, Mohammadali

    2014-01-01

    Background: Sore throat and hoarseness are the most frequent subjective complaints after tracheal intubation for general anesthesia. We conducted a prospective, randomized, double-blind, placebo controlled study to evaluate the efficacy of intravenous (IV) dexamethasone plus ketamine gargle for reducing the incidence and severity of post-operative sore throat (POST) and hoarseness. Materials and Methods: 140 patients (aged 16-65 year) scheduled for elective surgery were enrolled. Patients were randomly allocated into four groups of 35 subjects each: Group K, gargled 40 mg ketamine in 30 ml saline; Group D, were infused 0.2 mg/kg IV dexamethasone; Group KD, gargled 40 mg ketamine in 30 ml saline plus 0.2 mg/kg IV dexamethasone; Group P (placebo) that received saline (gargle and IV). POST was graded at 0, 2, 4, 8, 16 and 24 h after operation on a four-point scale (0-3). Results: The incidence and severity of POST were significantly lower in Group KD, compared with the other groups at all times after tracheal extubation for up to 24 h (P < 0.05). Also the incidence and severity of hoarseness were significantly lower in each Groups of KD and K and D compared with group placebo (P < 0.05). Conclusion: The prophylactic use of 0.2 mg/kg of IV dexamethasone plus ketamine gargle significantly reduced the incidence and severity of POST compared with using each of these drugs alone or using placebo. PMID:25371869

  8. Substrate reduction therapy of glycosphingolipid storage disorders

    Microsoft Academic Search

    Johannes M. F. G. Aerts; Carla E. M. Hollak; Rolf G. Boot; Johanna E. M. Groener; Mario Maas

    2006-01-01

    Summary  In the last 15 years enormous progress has been made regarding therapy of type I Gaucher disease, a severely disabling disorder\\u000a characterized by intralysosomal storage of glucosylceramide in tissue macrophages. Effective enzyme replacement therapy of\\u000a type I Gaucher disease, based on chronic intravenous administration of mannose-terminated recombinant human glucocerebrosidase,\\u000a has been available since 1990 and has been applied in several

  9. 78 FR 58318 - Clinical Trial Design for Intravenous Fat Emulsion Products; Public Workshop

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-23

    ...Clinical Trial Design for Intravenous Fat Emulsion Products; Public Workshop AGENCY: Food...Clinical Trial Design for Intravenous Fat Emulsion Products.'' This workshop will provide...support registration of intravenous fat emulsion products. Date and Time: The...

  10. Intravenous ferric carboxymaltose for anaemia in pregnancy

    PubMed Central

    2014-01-01

    Background Iron deficiency is a common nutritional deficiency amongst women of childbearing age. Peri-partum iron deficiency anaemia (IDA) is associated with significant maternal, fetal and infant morbidity. Current options for treatment are limited: these include oral iron supplementation, which can be ineffective and poorly tolerated, and red blood cell transfusions, which carry an inherent risk and should be avoided. Ferric carboxymaltose is a new treatment option that may be better tolerated. The study was designed to assess the safety and efficacy of iron deficiency anaemia (IDA) correction with intravenous ferric carboxymaltose in pregnant women with mild, moderate and severe anaemia in the second and third trimester. Methods Prospective observational study; 65 anaemic pregnant women received ferric carboxymaltose up to 15 mg/kg between 24 and 40 weeks of pregnancy (median 35 weeks gestational age, SD 3.6). Treatment effectiveness was assessed by repeat haemoglobin (Hb) measurements and patient report of well-being in the postpartum period. Safety was assessed by analysis of adverse drug reactions and fetal heart rate monitoring during the infusion. Results Intravenous ferric carboxymaltose infusion significantly increased Hb values (p?

  11. Intravenous coronary angiography with synchrotron radiation

    NASA Astrophysics Data System (ADS)

    Dix, W.-R.; Besch, H. J.; Graeff, W.; Hamm, C. W.; Illing, G.; Kupper, W.; Lohmann, M.; Meinertz, T.; Menk, R. H.; Reime, B.; Rust, C.; Schildwächter, L.; Walenta, A. H.

    1996-01-01

    Worldwide several systems for Digital Subtraction Angiography in energy subtraction mode (dichromography) with synchrotron radiation are developed. Two of the systems-the system NIKOS in the Hamburger Synchrotronstrahlungslabor HASYLAB in Hamburg and the system in Brookhaven-allow investigations of patients. The aim of the work is to visualize coronary arteries down to 1 mm diameter with an iodine mass density of 1 mg/cm2, thus allowing non-invasive investigations by intravenous application of the contrast medium. The two images for subtraction are simultaneously taken with photon energies just below and above the iodine K-edge (33.17 keV) in a line scan mode. In principle the system NIKOS consists of six main parts: A 20-pole wiggler with a total length of 2.4 m and a field of 1.26 T is installed in the storage ring DORIS at DESY in Hamburg. In a two beam monochromator two bent perfect Si(111) crystals in Laue geometry are used for filtering the quasi-monochromatic beams with a bandwidth of 180 eV out of the white synchrotron radiation beam. In a safety system three independent very fast beam shutters are installed which close within less than 10 ms at any malfunction of the system. Because the line scan mode is used a scanning device moves the patient with up to 50 cm/s through the two monochromatic beams. As a detector a two-line ionization chamber with a spatial resolution of 0.4 mm is installed. The chamber has a dynamic range of 39,000:1 and reads a line within 0.73 ms. The quantum efficiency for 33 keV photons is 85%. The computer system is used for control of the system, data acquisition, image processing and presentation. Since 1990 thirty patients were studied with the system NIKOS. In all cases follow-up investigations after interventions like bypass surgery, angioplasty or rotablation were performed. Intravenous angiograms from investigations with version III of the system are presented.

  12. Treatment of refractory necrobiotic xanthogranulomas with extracorporeal photopheresis and intravenous immunoglobulin.

    PubMed

    Liszewski, Walter; Wisniewski, Joy D; Safah, Hana; Boh, Erin E

    2014-01-01

    Necrobiotic xanthogranuloma (NXG) is a disease of fibrotic or telangiectatic granulomatous papules and nodules that can ultimately progress into ulcerated plaques. Although the exact cause of NXG is unknown, it most often occurs in patients with paraproteinemia secondary to a hematologic disease. Consequently, therapy for NXG is targeted at treating the underlying hematologic disease, and subsequent paraproteinemia, with alkylating agents, antimetabolites, radiation, and/or immunosuppressive agents. Cases refractory to these therapies often have poor outcomes. We report the successful treatment of two patients with refractory NXG with two different modalities: extracorporeal photopheresis (ECP) and intravenous immunoglobulin (IVIG). The first case shows a patient without paraproteinemia who had success with ECP and IVIG, and the second is a patient with paraproteinemia treated effectively with IVIG. The beneficial response of our patients to IVIG, as well as ECP, shows that they may be an effective treatment option for refractory NXG. PMID:24910296

  13. Low-dose intravenous heparin infusion in patients with aneurysmal subarachnoid hemorrhage: a preliminary assessment

    PubMed Central

    Simard, J. Marc; Aldrich, E. Francois; Schreibman, David; James, Robert F.; Polifka, Adam; Beaty, Narlin

    2015-01-01

    Object Aneurysmal subarachnoid hemorrhage (aSAH) predisposes to delayed neurological deficits, including stroke and cognitive and neuropsychological abnormalities. Heparin is a pleiotropic drug that antagonizes many of the pathophysiological mechanisms implicated in secondary brain injury after aSAH. Methods The authors performed a retrospective analysis in 86 consecutive patients with Fisher Grade 3 aSAH due to rupture of a supratentorial aneurysm who presented within 36 hours and were treated by surgical clipping within 48 hours of their ictus. Forty-three patients were managed postoperatively with a low-dose intravenous heparin infusion (Maryland low-dose intravenous heparin infusion protocol: 8 U/kg/hr progressing over 36 hours to 10 U/kg/hr) beginning 12 hours after surgery and continuing until Day 14 after the ictus. Forty-three control patients received conventional subcutaneous heparin twice daily as deep vein thrombosis prophylaxis. Results Patients in the 2 groups were balanced in terms of baseline characteristics. In the heparin group, activated partial thromboplastin times were normal to mildly elevated; no clinically significant hemorrhages or instances of heparin-induced thrombocytopenia or deep vein thrombosis were encountered. In the control group, the incidence of clinical vasospasm requiring rescue therapy (induced hypertension, selective intraarterial verapamil, and angioplasty) was 20 (47%) of 43 patients, and 9 (21%) of 43 patients experienced a delayed infarct on CT scanning. In the heparin group, the incidence of clinical vasospasm requiring rescue therapy was 9% (4 of 43, p = 0.0002), and no patient suffered a delayed infarct (p = 0.003). Conclusions In patients with Fisher Grade 3 aSAH whose aneurysm is secured, postprocedure use of a low-dose intravenous heparin infusion may be safe and beneficial. PMID:24032706

  14. Endovascular Therapy for Acute Ischemic Stroke: A Systematic Review and Meta-analysis

    PubMed Central

    Singh, Balwinder; Parsaik, Ajay K.; Prokop, Larry J.; Mittal, Manoj K.

    2013-01-01

    Objective To consolidate the evidence from randomized trials for the use of endovascular therapy (ET) in patients with acute ischemic stroke. Methods We searched major databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus) from their inception to February 12, 2013, for randomized trials evaluating the efficacy of ET compared with standard of care for acute ischemic stroke. Pooled absolute and relative risk estimates were synthesized by using a random-effects model. Heterogeneity was assessed by using Q statistic and I2 statistic. Subset analysis was performed for patients with severe stroke (National Institutes of Health Stroke Scale score ?20). The study was conducted from January 15, 2013 to April 30, 2013. Results Of the 1252 retrieved articles, 5 randomized trials enrolling 1197 patients with acute ischemic stroke were included. Seven hundred eleven patients received ET, and 486 received intravenous (IV) tissue plasminogen activator. There was no significant improvement in any of the outcomes in patients receiving ET compared with those receiving IV thrombolysis. On subgroup analysis, ET was found to have better outcomes in patients with severe stroke (National Institutes of Health Stroke Scale score ?20), showing a dose-response gradient and improving excellent, good, and fair outcomes by an additional 4%, 7%, and 13%, respectively, compared with IV thrombolysis. Conclusion Overall, ET is not superior to IV thrombolysis for acute ischemic strokes (level B recommendation). However, ET showed promise and improved outcomes in patients with severe strokes, but the evidence is limited due to sample size. There is a need for further trials evaluating the role of ET in this high-risk group. PMID:24079677

  15. Fresenius Kabi had an outstanding year in 2008. Once again we saw strong sales and earnings growth. The acquisitions of APP Pharmaceuticals and Dabur Pharma marked two important advances in our progress toward global market leadership in intravenously administered generic drugs

    Microsoft Academic Search

    Fresenius Kabi; Fresenius Helios; Fresenius Vamed

    2009-01-01

    Fresenius Kabi specializes in the therapy and care of chron- ically and critically ill patients, providing clinical nutrition, infusion therapies, and related medical devices. Our products cover the total range for patient care: emergency cases, dur- ing surgery, intensive care, hospital wards, and outpatient care. For infusion therapy, we provide infusion solutions, blood volume replacement products, and intravenously administered generic

  16. Pharmacokinetics of Acyclovir after Intravenous Infusion of Acyclovir and after Oral Administration of Acyclovir and Its Prodrug Valacyclovir in Healthy Adult Horses

    Microsoft Academic Search

    B. Garre ´; K. Shebany; A. Gryspeerdt; K. Baert; K. van der Meulen; H. Nauwynck; P. Deprez; P. De Backer; S. Croubels

    2007-01-01

    The purpose of this study was twofold. The first aim was to evaluate the oral bioavailability and pharmacokinetics (PKs) of acyclovir in horses after intravenous (i.v.) administration and after oral administration of acyclovir and its prodrug, valacyclovir. Second, we aimed to combine these PK data with pharmacodynamic (PD) information, i.e., 50% effective concentrations (EC50 values) from in vitro studies, to

  17. Comparison of ELISA and LC-MS/MS for the measurement of flunixin plasma concentrations in beef cattle after intravenous and subcutaneous administration

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Eight cattle (288 +/- 22 kg) were treated with 2.2 mg/kg of flunixin in a cross-over design using subcutaneous (SC) and intravenous (IV) administration. The limit of detection (LOD) was 0.42 ng/mL and the working range was 0.76 - 66.4 ng/mL for ELISA when adjusted for dilution. The linear calibrat...

  18. The use of specific opioid agonists and antagonists to delineate the vagally mediated antinociceptive and cardiovascular effects of intravenous morphine.

    PubMed

    Randich, A; Robertson, J D; Willingham, T

    1993-02-19

    Intravenous (i.v.) administration of morphine produces a dose-dependent inhibition of the tail-flick (TF) reflex, depressor response, and bradycardia in the rat. Some of these effects depend on interactions of i.v. morphine with peripheral opioid receptors and the integrity of cervical vagal afferents. The present studies used the relatively specific mu, delta, and kappa opioid receptor agonists (DAGO, DPDPE or U-50,488H) and the relatively specific mu, delta, and kappa opioid receptor antagonists (beta-FNA, naloxonazine, naltrindole or nor-BNI) in either intact rats or rats with bilateral cervical vagotomy (CVAG) to delineate the vagal afferent/opioid-mediated components of these effects. I.v. administration of DAGO in intact rats produced a dose-dependent inhibition of the TF reflex, depressor response, and bradycardia virtually identical to those produced by i.v. morphine. All of these effects of either i.v. DAGO or i.v. morphine were significantly attenuated by either bilateral CVAG or pre-treatment with the mu 2 opioid receptor antagonist beta-FNA. Pre-treatment with the mu 1 opioid receptor antagonist naloxonazine affected i.v. DAGO-induced inhibition of the TF reflex and bradycardia, but had no significant effects on i.v. morphine-produced responses. I.v. administration of DPDPE produced a dose-dependent pressor response, but had no marked effects on the either the TF reflex or heart rate (HR). The pressor response was unaffected by either bilateral CVAG or pre-treatment with naltrindole, naloxone, hexamethonium, or bertylium. i.v. administration of U-50,488H produced a depressor response and bradycardia, but had no significant effect on the TF reflex. The depressor response and bradycardia produced by i.v. U-50,488H were unaffected by bilateral CVAG, but could be antagonized by pre-treatment with either nor-BNI or naloxone. These studies suggest that the vagal afferent-mediated antinociceptive and cardiovascular effects of i.v. morphine are primarily mediated by interactions with low affinity mu 2 opioid receptors. PMID:8096421

  19. Patient Satisfaction with Intravenous Acetaminophen: A Pooled Analysis of Five Randomized, Placebo-Controlled Studies in the Acute Postoperative Setting.

    PubMed

    Apfel, Christian C; Souza, Kimberly; Portillo, Juan; Dalal, Poorvi; Bergese, Sergio D

    2014-01-16

    Intravenous (IV) acetaminophen has been shown to reduce postoperative pain and opioid consumption, which may lead to increased patient satisfaction. To determine the effect IV acetaminophen has on patient satisfaction, a pooled analysis from methodologically homogenous studies was conducted. We obtained patient-level data from five randomized, placebo-controlled studies in adults undergoing elective surgery in which patient satisfaction was measured using a 4-point categorical rating scale. The primary endpoint was "excellent" satisfaction and the secondary endpoint was "good" or "excellent" satisfaction at 24 hr after first study drug administration. Bivariate analyses were conducted using the chi-square test and Student's t-test and multivariable analyses were conducted using logistic regression analysis. Patients receiving IV acetaminophen were more than twice as likely as those who received placebo to report "excellent" patient satisfaction ratings (32.3% vs. 15.9%, respectively). Of all variables that remained statistically significant in the multivariable analysis (i.e., type of surgery, duration of anesthesia, last pain rating, and opioid consumption), IV acetaminophen had the strongest positive effect on "excellent" patient satisfaction with an odds ratio of 2.76 (95% CI 1.81-4.23). Results for "excellent" or "good" satisfaction were similar. When given as part of a perioperative analgesic regimen, IV acetaminophen was associated with significantly improved patient satisfaction. PMID:24433365

  20. Boron distribution in the normal rat brain after intravenous injection of boronophenylalanine-fructose.

    PubMed

    Shibata, Yasushi

    2008-03-01

    Boron neutron capture therapy (BNCT) is an experimental form of radiation therapy for malignant brain tumors and peripheral melanoma. The micro-distribution of the boron compound is critical to determine the radiation effects for both tumors and normal tissue. In the current dose calculation of BNCT, normal brain tissue is considered to have a homogeneous boron concentration. The purpose of this study was to examine the structure-specific boron concentration in normal rat neural tissue. At 10, 30 and 60 min after intravenous injection of 300 mg/kg boronophenylalanine-fructose to 10-week-old CD Fisher rats, neural tissue and blood were collected. Various neural structures were anatomically and histologically identified and specific boron concentrations were analyzed using high-resolution quantitative autoradiography. At 60 min after the injection, only the pituitary gland showed a higher boron concentration than that in blood, with the former being threefold higher. All other neural structures showed lower boron concentrations than that in blood. The present study thus demonstrated an extremely high boron concentration in the pituitary gland following intravenous injection of boronophenylalanine-fructose. In clinical trials of BNCT using an epithermal neutron beam, the radiation dose to the pituitary gland should be carefully evaluated. PMID:18026910

  1. Should the ASCO/ASH Guidelines for the use of intravenous iron in cancer- and chemotherapy-induced anemia be updated?

    PubMed

    Gafter-Gvili, Anat; Steensma, David P; Auerbach, Michael

    2014-05-01

    Coadministration of intravenous (IV) iron improves responses to erythropoiesis-stimulating agents (ESAs) in the treatment of cancer-associated (CAA) and chemotherapy-induced anemia (CIA). Twelve prospective studies have demonstrated synergy between parenteral iron and ESAs, with variable degrees of improved hemoglobin (Hgb) response rates, shorter times to target Hgb levels, and a lower ESA dose required for equivalent Hgb responses. Clinically significant adverse events (AEs) with currently available IV iron products are uncommon. Pretreatment serum hepcidin levels may predict response magnitude. Safety concerns among many oncologists are driven by reports of serious AEs from older IV iron formulations that are no longer available, and misinterpretation of the nature and frequency of minor infusion reactions. Premedication with antihistamines is of unproven benefit and can cause symptoms that mimic anaphylaxis, prompting intervention with vasopressors and converting self-limited reactions into hemodynamically significant AEs. Payer rules proscribing the administration of ESAs and IV iron on the same day also have limited the clinical adoption of IV iron and ESA coadministration. At a time when financial resources are scarce, the ability to reduce use of costly ESAs is beneficial. Despite a favorable risk/benefit ratio for IV iron in CAA and CIA, current IV iron recommendations in guidelines from ASCO/ASH, NCCN, and ESMO are inconsistent. The authors believe more routine use of IV iron for CAA and CIA is appropriate in view of existing evidence, and suggest reconsideration of the current ASCO/ASH guidelines, which state "there is insufficient evidence to consider the use of intravenous iron as a standard of care." PMID:24812134

  2. Repeated intravenous doxapram induces phrenic motor facilitation

    PubMed Central

    Sandhu, MS; Lee, KZ; Gonzalez-Rothi, EJ; Fuller, DD

    2013-01-01

    Doxapram is a respiratory stimulant used to treat hypoventilation. Here we investigated whether doxapram could also trigger respiratory neuroplasticity. Specifically, we hypothesized that intermittent delivery of doxapram at low doses would lead to long-lasting increases (i.e., facilitation) of phrenic motor output in anesthetized, vagotomized, and mechanically-ventilated rats. Doxapram was delivered intravenously in a single bolus (2 or 6 mg/kg) or as a series of 3 injections (2 mg/kg) at 5 min intervals. Control groups received pH-matched saline injections (vehicle) or no treatment (anesthesia time control). Doxapram evoked an immediate increase in phrenic output in all groups, but a persistent increase in burst amplitude only occurred after repeated dosing with 2 mg/kg. At 60 min following the last injection, phrenic burst amplitude was 168±24% of baseline (%BL) in the group receiving 3 injections (P < 0.05 vs. controls), but was 103±8%BL and 112±4%BL in the groups receiving a single dose of 2 or 6 mg/kg, respectively. Following bilateral section of the carotid sinus nerves, the acute phrenic response to doxapram (2 mg/kg) was reduced by 68% suggesting that at low doses the drug was acting primarily via the carotid chemoreceptors. We conclude that intermittent application of doxapram can trigger phrenic neuroplasticity, and this approach might be of use in the context of respiratory rehabilitation following neurologic injury. PMID:24013015

  3. Intravenous lipids in home parenteral nutrition.

    PubMed

    Pironi, Loris; Agostini, Federica; Guidetti, Mariacristina

    2015-01-01

    Intravenous lipid emulsions (IVLEs) are an important component of the nutritional admixtures for patients on long-term home parenteral nutrition (HPN) for chronic intestinal failure (CIF). IVLEs are primarily used as a source of energy and essential fatty acids, and the content of polyunsaturated fatty acids (PUFAs) is the most important characteristic of IVLEs. IVLEs rich in n-6 PUFAs may have a pro-inflammatory effect, whereas those rich in n-3 PUFAs may exert an anti-inflammatory effect. Other components to be considered are the risk of lipid peroxidation and the contents of ?-tocopherol and phytosterols. Published studies were reviewed to determine the effects of the commercially available IVLEs on essential fatty acid status, liver function tests, lipid peroxidation and inflammatory indices, and ?-tocopherol status, as well as their clinical safety and efficacy in patients on HPN. Investigations on the efficacy of fish oil-based IVLEs, which are rich in n-3 PUFAs, in the treatment of parenteral nutrition-associated liver disease (PNALD) in adult patients on HPN for CIF were also analyzed. The current commercial IVLE formulations have similar clinical safety profiles and efficacies and can prevent the development of essential fatty acid deficiency in adults on HPN for CIF. IVLE with a low content of n-6 PUFAs and with or without increased n-3 PUFA content may reduce the risk of PNALD. Fish oil-based IVLE, which is rich in n-3 PUFAs, may be effective in reversing hepatic cholestasis due to PNALD. PMID:25471810

  4. Repeated intravenous doxapram induces phrenic motor facilitation.

    PubMed

    Sandhu, M S; Lee, K Z; Gonzalez-Rothi, E J; Fuller, D D

    2013-12-01

    Doxapram is a respiratory stimulant used to treat hypoventilation. Here we investigated whether doxapram could also trigger respiratory neuroplasticity. Specifically, we hypothesized that intermittent delivery of doxapram at low doses would lead to long-lasting increases (i.e., facilitation) of phrenic motor output in anesthetized, vagotomized, and mechanically-ventilated rats. Doxapram was delivered intravenously in a single bolus (2 or 6mg/kg) or as a series of 3 injections (2mg/kg) at 5min intervals. Control groups received pH-matched saline injections (vehicle) or no treatment (anesthesia time control). Doxapram evoked an immediate increase in phrenic output in all groups, but a persistent increase in burst amplitude only occurred after repeated dosing with 2mg/kg. At 60min following the last injection, phrenic burst amplitude was 168±24% of baseline (%BL) in the group receiving 3 injections (P<0.05 vs. controls), but was 103±8%BL and 112±4%BL in the groups receiving a single dose of 2 or 6mg/kg, respectively. Following bilateral section of the carotid sinus nerves, the acute phrenic response to doxapram (2mg/kg) was reduced by 68% suggesting that at low doses the drug was acting primarily via the carotid chemoreceptors. We conclude that intermittent application of doxapram can trigger phrenic neuroplasticity, and this approach might be of use in the context of respiratory rehabilitation following neurologic injury. PMID:24013015

  5. [The influence of depression on the effect of Tropisetron in the therapy of fibromyalgia].

    PubMed

    Stratz, T; Varga, B; Müller, W

    2003-02-01

    As described elsewhere the oral administration of 5 mg of the 5-HT3-receptor-antagonist Tropisetron in fibromyalgia exhibited less amelioration of pain in patients with a depression in comparison to patients without depression. Since an intravenous treatment seems to increase the effect of Tropisetron, the question arises whether patients with depression profit from the intravenous therapy. Methods 68 out patients with fibromyalgia according to ACR-criteria were enrolled in the study. The patients filled in a VAS pain and the Beck Depression Inventory (BDI) before and after a bolus i.v. injection of 5 mg Tropisetron for 5 days [Beck AT, Steer Ra. Beck-Depression-Inventory (BDI) In: Hautzinger M (Hrsg der dt. Ausg.). Testhandbuch. 1. Auflage Bern: Verlag Hans Huber, 1994]. In the beginning the patients had to have > or = 40 mm in the VAS pain from 0-100 mm. The patients were divided into three groups: group 1 = patients with a BDI<19 without experience with antidepressive drugs (n=26); group 2=patients with a BDI > or = 19 (n=22) and negative experience with antidepressive substances, and group 3=patients with a BDI > or = 19 and an accompanying antidepressant drug therapy and some benefit under this therapy (n=20). Results Before the therapy there was no significant difference in VAS pain in the groups, but in BDI there was a significant difference between group 1 (BDI mean value 11.5) in comparison to group 2 (BDI mean value 26.1) and group 3 (BDI mean value 24.8). After therapy all three groups had a significant amelioration of pain: group 1: p=0.000023; group 2: p=0.00073; group 3: p=0.0145. There was a significant difference between the group with BDI<19 and the group with antidepressant drug in amelioration of pain (p=0.044). A significant correlation was found in group 2 with Beck > or = 19 between amelioration of pain and BDI after therapy (p=0.008, r=0.666). In this group a pain-reactive depression and in group 3 an endogenous depression must be discussed. PMID:12624803

  6. Exceptionally Stable Fluorous Emulsions for the Intravenous Delivery of Volatile General Anesthetics

    PubMed Central

    Jee, Jun-Pil; Parlato, Maria C.; Perkins, Mark G.; Mecozzi, Sandro; Pearce, Robert A.

    2012-01-01

    Background Intravenous delivery of volatile fluorinated anesthetics has a number of potential advantages when compared to the current inhalation method of administration. We reported previously that the IV delivery of sevoflurane can be achieved through an emulsion composed of a linear fluorinated diblock copolymer, a stabilizer, and the anesthetic. However, this original emulsion was subject to particle size growth that would limit its potential clinical utility. We hypothesized that the use of bulkier fluorous groups and smaller poly(ethylene glycol) moieties in the polymer design would result in improved emulsion stability while maintaining anesthetic functionality. Methods The authors prepared emulsions incorporating sevoflurane, perfluorooctyl bromide as a stabilizing agent, and combinations of linear fluorinated diblock copolymer and a novel dibranched fluorinated diblock copolymer. Emulsion stability was assessed using dynamic light scattering. The ability of the emulsions to induce anesthesia was tested in vivo by administering them intravenously to fifteen male Sprague-Dawley rats and measuring loss of the forepaw righting reflex. Results 20% (volume/volume) sevoflurane emulsions incorporating mixtures of dibranched- and linear diblock copolymers had improved stability, with those containing an excess of the dibranched polymers displaying stability of particle size for over one year. The ED50s for loss of forepaw righting reflex were all similar, and ranged between 0.55 and 0.60 ml/kg body weight. Conclusions Hemifluorinated dibranched polymers can be used to generate exceptionally stable sevoflurane nanoemulsions, as required of formulations intended for clinical use. Intravenous delivery of the emulsion in rats resulted in induction of anesthesia with rapid onset and smooth and rapid recovery. PMID:22354241

  7. [Setting of compression therapy].

    PubMed

    Planinsek Rucigaj, Tanja; Huljev, Dubravko

    2013-10-01

    Compression therapy is the basic therapy in phlebology and lymphology. The pressure under the bandages has to exceed the intravenous pressure especially in standing position. Different compression materials such as short stretch systems, long stretch bandages and compression garments work differently on ambulatory venous hypertension, speed of reducing edema and arterial flow. Compression with high stiffness, inelastic materials is more effective than compression with low stiffness, elastic materials. These materials have to be placed correctly. Inelastic systems should be applied with high initial pressure because the pressure will loose at some time after walking. Even after one week of wearing, inelastic bandages keep higher resting and working pressure during walking than elastic bandages. However, more important is that they have lower resting pressure than elastic materials. Long stretch bandages and compression garments with great extensibility ensure low working pressure and higher resting pressure than short stretch systems. PMID:24371979

  8. Attenuation of hemodynamic response to laryngoscopy and orotracheal intubation using intravenous clonidine

    PubMed Central

    Arora, Sakshi; Kulkarni, Anita; Bhargava, Ajay Kumar

    2015-01-01

    Background and Aims: Alpha-2 agonists are being increasingly used as adjuncts in general anesthesia and the present study was carried out to study the effect of clonidine as an adjuvant to low dose fentanyl in attenuating the hemodynamic response to laryngoscopy and orotracheal intubation. Materials and Methods: Ninety female patients belonging to American Society of Anesthesiologists (ASA) physical status I, II, and III in age group 25-65 years, body mass index (BMI) 21-26 kg/m2, and diagnosed as carcinoma breast scheduled for breast surgery were included in this Prospective, randomized, placebo-controlled study. One-way analysis of variance (ANOVA), paired t-test, and chi-square test was applied where deemed appropriate. P-value at or below the level of 0.05 was considered as statistically significant. Results: Intravenous (IV) clonidine 1.0 ?g kg-1 and clonidine 2.0 ?g kg-1 significantly attenuated the hyperdynamic response to laryngoscopy and intubation. Clonidine 2.0 ?g kg-1 was associated with adverse effects like hypotension at the time of induction and postoperative sedation which was not observed with clonidine 1.0 ?g kg-1. Conclusions: A single intravenous low dose clonidine (1.0 ?g kg-1) when combined with low dose fentanyl (2 ?g kg-1) is a practical, pharmacological and safe method with minimal side effects to attenuate the hyperdynamic response to laryngoscopy and intubation.

  9. Can intravenous patient-controlled analgesia be omitted in patients undergoing laparoscopic surgery for colorectal cancer?

    PubMed Central

    Choi, Young Yeon; Park, Jun Seok; Park, Soo Yeun; Kim, Hye Jin; Yeo, Jinseok; Kim, Jong-Chan; Park, Sungsik

    2015-01-01

    Purpose Opioid-based intravenous patient-controlled analgesia (IV-PCA) is a popular method of postoperative analgesia, but many patients suffer from PCA-related complications. We hypothesized that PCA was not essential in patients undergoing major abdominal surgery by minimal invasive approach. Methods Between February 2013 and August 2013, 297 patients undergoing laparoscopic surgery for colorectal cancer were included in this retrospective comparative study. The PCA group received conventional opioid-based PCA postoperatively, and the non-PCA group received intravenous anti-inflammatory drugs (Tramadol) as necessary. Patients reported their postoperative pain using a subjective visual analogue scale (VAS). The PCA-related adverse effects and frequency of rescue analgesia were evaluated, and the recovery rates were measured. Results Patients in the PCA group experienced less postoperative pain on days 4 and 5 after surgery than those in the non-PCA group (mean [SD] VAS: day 4, 6.2 [0.3] vs. 7.0 [0.3], P = 0.010; and day 5, 5.1 [0.2] vs. 5.5 [0.2], P = 0.030, respectively). Fewer patients in the non-PCA group required additional parenteral analgesia (41 of 93 patients vs. 53 of 75 patients, respectively), and none in the non-PCA group required rescue PCA postoperatively. The incidence of postoperative nausea and vomiting was significantly higher in the non-PCA group than in the PCA group (P < 0.001). The mean (range) length of hospital stay was shorter in the non-PCA group (7.9 [6-10] days vs. 8.7 [7-16] days, respectively, P = 0.03). Conclusion Our Results suggest that IV-PCA may not be necessary in selected patients those who underwent minimal invasive surgery for colorectal cancer. PMID:25692119

  10. Intravenous dextromethorphan to human volunteers: relationship between pharmacokinetics and anti-hyperalgesic effect.

    PubMed

    Duedahl, Tina H; Dirks, Jesper; Petersen, Kamilla B; Romsing, Janne; Larsen, Niels-Erik; Dahl, Jorgen B

    2005-02-01

    The aim of this study was to investigate the effect of dextromethorphan (DM) 0.5 mg/kg administered intravenously (i.v.) on hyperalgesia and pain after a tissue injury in human volunteers, and to describe the relationship between pharmacokinetic and pharmacodynamic data. The heat-capsaicin sensitisation model, a well-established experimental hyperalgesia model was induced in 24 healthy, male volunteers aged 21-35 years. The subjects received i.v. DM 0.5 mg/kg or isotonic saline on two separate study sessions. The primary outcome measure from 0 to 3 h was reduction in area of established secondary hyperalgesia. Secondary outcome measures were reduction in area of secondary hyperalgesia in response to brief thermal stimulation, heat pain detection thresholds and painfulness after tonic heat pain. Blood samples were collected throughout the study to describe the relationship between pharmacokinetic and pharmacodynamic data. Intravenous DM 0.5 mg/kg significantly reduced areas of established secondary hyperalgesia with an average of 39% (P<0.05). Development of secondary hyperalgesia was substantially prevented by DM (P<0.05). No significant effect was seen on either heat pain detection thresholds or after tonic heat pain. The pharmacokinetic-pharmacodynamic relationship showed a large inter-subject variation with a mean delay in effect of nearly 2 h in relation to peak serum concentration. The results strongly indicate that DM is an anti-hyperalgesic drug. The delay in effect may be explained by several mechanisms and suggests that timing of DM administration is an essential factor for using the drug in clinical settings. PMID:15661445

  11. Intravenously administered vasodilatory prostaglandins increase retinal and choroidal blood flow in rats.

    PubMed

    Mori, Asami; Saito, Maki; Sakamoto, Kenji; Nakahara, Tsutomu; Ishii, Kunio

    2007-01-01

    We established an experimental system for measuring blood flow in the rat fundus and examined whether intravenously administered vasodilatory prostaglandins (PGE(1), PGE(2), and PGI(2)), 8-(4-chlorophenylthio)-cAMP (a cAMP analogue), and nicardipine (a Ca(2+)-channel blocker) increase fundus blood flow (FBF). Under artificial ventilation, rats were injected with tetrodotoxin (50 microg/kg, i.v.) to eliminate any nerve activity and prevent movement of the eye. After tetrodotoxin, the rats were infused with norepinephrine (0.3 - 0.5 microg . kg(-1) . min(-1)) and epinephrine (2.7 - 4.5 microg . kg(-1) . min(-1)) simultaneously to maintain adequate systemic circulation. We found that intravenous infusion of PGE(1) (2 - 10 microg . kg(-1) . min(-1)), PGE(2) (3 - 30 microg . kg(-1) . min(-1)), and PGI(2) (1 - 10 microg . kg(-1) . min(-1)) increased the FBF in a dose-dependent manner. The vasodilatory PGs decreased arterial pressure, whereas they did not affect heart rate. Like vasodilatory PGs, 8-(4-chlorophenylthio)-cAMP (30 micromol/kg, i.v.) increased FBF and decreased arterial pressure. While infusion of nicardipine (0.3 - 3 microg . kg(-1) . min(-1)) produced comparable depressor responses with those to vasodilatory PGs and the cAMP analogue, it did not increase FBF. These results suggest that vasodilatory PGs and cAMP act more selectively than Ca(2+)-channel blockers on retinal/choroidal blood vessels. Therefore, the vasodilatory PGs might be considered to be possible candidates for the therapeutics to treat disorders of retinal/choroidal circulation. PMID:17229993

  12. Knowledge about AIDS and high-risk behavior among intravenous drug users in New York City.

    PubMed

    Selwyn, P A; Feiner, C; Cox, C P; Lipshutz, C; Cohen, R L

    1987-12-01

    Two hundred and sixty-one intravenous (IV) drug users, distributed between a methadone maintenance program and a large detention facility in New York City, were interviewed about knowledge of AIDS, needle use practices, and risk-reduction efforts. Ninety-seven per cent of subjects recognized needle-sharing as an AIDS risk factor; subjects showed less awareness about the effectiveness of certain risk-reduction techniques and tended to over-estimate the risk of casual contact. Of those still sharing needles at the time of first becoming aware of AIDS, 63% reported having subsequently either stopped needle-sharing or ceased IV drug use entirely. Logistic regression analysis indicated that continued needle-sharing behavior was associated with the detention facility site and lower scores on an AIDS knowledge questionnaire; reduced needle-sharing was more evident among methadone program patients and among subjects with greater knowledge about AIDS. The most common reasons for continued needle-sharing among those who continued to share needles despite knowledge of risk were: 'need to inject drugs, with no clean needle available' and 'only share with close friend or relative', offered by 46 and 45% of subjects, respectively. Results suggest that certain subgroups of IV drug users have adopted risk-reduction measures in response to AIDS. Expanded educational programs, increased drug treatment capacity, and additional strategies addressing drug users' access to sterile injection equipment and the social context of needle-sharing may be necessary to curb the further spread of AIDS among IV drug users. PMID:3126773

  13. Intramuscular midazolam versus intravenous lorazepam for the prehospital treatment of status epilepticus in the pediatric population

    PubMed Central

    Welch, Robert D.; Nicholas, Katherine; Durkalski-Mauldin, Valerie L.; Lowenstein, Daniel H.; Conwit, Robin; Mahajan, Prashant V.; Lewandowski, Christopher; Silbergleit, Robert

    2015-01-01

    Summary Objective To examine the effectiveness of intramuscular (IM) midazolam versus intravenous (IV) lorazepam for the treatment of pediatric patients with status epilepticus (SE) in the prehospital care setting. Methods This multicenter clinical trial randomized patients diagnosed with SE to receive either IM midazolam or IV lorazepam administered by paramedics in the prehospital care setting. Included in this secondary analysis were only patients younger than 18 years of age. Evaluated were the associations of the treatment group (IM vs. IV) with the primary outcome, defined as seizure cessation prior to emergency department (ED) arrival, and with patient characteristics, time to important events, and adverse events. Descriptive statistics and 99% confidence intervals (CIs) were used for the analysis. Results Of 893 primary study subjects, 120 met criteria for this study (60 in each treatment group). There were no differences in important baseline characteristics or seizure etiologies between groups. The primary outcome was met in 41 (68.3%) and 43 (71.7%) of subjects in the IM and IV groups, respectively (risk difference [RD] ?3.3%, 99% CI ?24.9% to 18.2%). Similar results were noted for those younger than 11 years (RD ?1.3%, 99% CI ?25.7% to 23.1%). Time from initiating the treatment protocol was shorter for children who received IM midazolam, mainly due to the shorter time to administer the active treatment. Safety profiles were similar. Significance IM midazolam can be rapidly administered and appears to be safe and effective for the management of children with SE treated in the prehospital setting. The results must be interpreted in the context of the secondary analysis design and sample size of the study. PMID:25597369

  14. Reperfusion therapy of acute ischaemic stroke and acute myocardial infarction: similarities and differences

    PubMed Central

    Widimsky, Petr; Coram, Rita; Abou-Chebl, Alex

    2014-01-01

    The evolution of reperfusion therapy in acute myocardial infarction and acute ischaemic stroke has many similarities: thrombolysis is superior to placebo, intra-arterial thrombolysis is not superior to intravenous (i.v.), facilitated intervention is of questionable value, and direct mechanical recanalization without thrombolysis is proven (myocardial infarction) or promising (stroke) to be superior to thrombolysis—but only when started with no or minimal delay. However, there are also substantial differences. Direct catheter-based thrombectomy in acute ischaemic stroke is more difficult than primary angioplasty (in ST-elevation myocardial infarction [STEMI]) in many ways: complex pre-intervention diagnostic workup, shorter time window for clinically effective reperfusion, need for an emergent multidisciplinary approach from the first medical contact, vessel tortuosity, vessel fragility, no evidence available about dosage and combination of peri-procedural antithrombotic drugs, risk of intracranial bleeding, unclear respective roles of thrombolysis and mechanical intervention, lower number of suitable patients, and thus longer learning curves of the staff. Thus, s