Meningitis due to vancomycin-resistant Enterococcus faecium successfully treated with combined intravenous and intraventricular chloramphenicol.
Explore the source record for details and available documents.
Anti-Bacterial Agents↗
SEARCH · PubMed Health
Results for “Infusions, Intraventricular”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Intraventricular morphine for intractable cancer pain: rationale, methods, clinical results.
The experience with the administration of intraventricular morphine for the control of malignant pain in 197 patients is analyzed. Small doses of morphine injected via a ventricular reservoir provided satisfactory control of otherwise intractable pain in terminal cancer-patients. Complete analgesia together with a favourable behavioral response was obtained without noticeable neurological changes or side-effects annoying or severe enough for the patients to discontinue therapy. Tolerance was much less marked than with parenteral opiates. Chronic intraventricular therapy can be safely performed on an outpatient basis by injecting the opiate once or twice a day. The method may be improved by using refillable continuous-infusion devices and new drugs, able to retain the analgesic effects of morphine while eliminating the unwanted ones.
Adolescent↗
A pressor response to intraventricular injections of carbachol.
Explore the source record for details and available documents.
Animals↗
The clinical impact of dynamic intraventricular obstruction during dobutamine stress echocardiography.
We selected 73 consecutive patients without myocardial-infarction, hypertrophic cardiomyopathy or hypertension complaining of effort chest discomfort/dyspnoea, and/or reporting exercise ischaemic ECG changes, and submitted them to simultaneous dobutamine stress echocardiography (DSE) and 99mTc tetrofosmin SPECT (T SPECT) and to coronary angiography to evaluate the clinical impact of intraventricular obstruction (IVO) during dobutamine infusion. Sixteen patients (22%, 7 males, mean age+/-SD 63+/-8 years, group 1) developed IVO (mean CW Doppler velocity+/-SD: 3.8+/-1.0 m/s) and 57 (41 males, mean age+/-SD 63+/-10 years, group 2) did not. The two groups had similar incidence of angina and ischaemic ECG changes at exercise tolerance test. DSE did not demonstrate wall motion abnormalities in any group 1 patient while T SPECT showed a perfusion defect in the only one with coronary artery disease (CAD). DSE reproduced symptoms in a higher percentage of patients with than without IVO, while there was no statistical difference in the reproduction of ischaemic ECG changes, despite CAD prevalence was much lower in group 1. Group 1 patients remained asymptomatic on beta-blockers at 12-month follow-up. Dobutamine-induced IVO, by reproducing symptoms, suggests that IVO plays a role in the clinical setting in patients without CAD complaining of unexplained reduced effort tolerance who should undergo DSE.
Adult↗
Inhibition of antigen-specific T cell trafficking into the central nervous system via blocking PECAM1/CD31 molecule.
Trafficking of antigen-specific T cells into the central nervous system (CNS) is an important initiating step in inflammation in the brain. In spite of the extensive knowledge about the role of adhesion molecules in T cell migration across peripheral vessels, the mechanism of the entry of antigen-specific T cells into the CNS is not known. This work was designed to study the regulatory roles of adhesion molecules in antigen-specific T cell migration into the CNS. Antigen-specific T cells were tracked in an in vivo migration assay using T cell receptor (TCR) transgenic mice having 95% of T cells specific for a defined antigen. pigeon cytochrome c (PCC). TCR transgenic mice were cannulated intraventricularly (IVT) for PCC antigen infusion and cerebrospinal fluid (CSF) sampling. Upon PCC infusion into the CNS, the number of alpha/beta TCR+ Vbeta3+ Mac1- cells in the CSF was characterized in the presence or absence of anti-adhesion molecule reagents. We found that antibodies against VCAM-1 (CD106), VLA-4 (CD49d/CD29), ICAM-1 (CD54), and LFA-1 (CD11a/CD18) did not influence the increased number of antigen-specific T cells in the CSF However, upon intravenous (i.v.) injection, anti-PECAM-1 (CD31) antibody or PECAM-Ig chimeric molecule inhibited the trafficking of alpha/beta TCR+ Vbeta3+ Mac1- cells into the CNS. The expression of PECAM-1 (CD31) was also up-regulated on antigen-specific T cells in a time-dependent manner in vitro upon antigenic stimulation. The antigen-induced activation of T cells in vivo was measured by CD44 and LFA-1 expression and found to be comparable between mPECAMIg-treated mice and wild-type serum control-treated groups. This indicates that CD31 inhibition of antigen-specific T cell accumulation in the CNS is probably not due to a functional inhibition of these cells. Finally, adoptive transfer of CFSE-labeled AND transgenic cells into naïve animals resulted in the accumulation of these cells in the CNS upon PCC IVT immunization that was also inhibited by mPECAMIg treatment. Hence, PECAM-1 (CD31) might play an important role in regulating antigen-specific T cells trafficking in CNS inflammatory diseases.
Animals↗
ALCOHOL CONSUMPTION IN RATS: EFFECTS OF INTRACRANIAL INJECTIONS OF ETHANOL.
After permanent implantation of intraventricular cannulae, rats were repeatedly infused with ethanol solutions of several concentrations. Pro-nounced preferences were exhibited for ordinarily noxious ethanol without prior oral exposure to this fluid. Since preferences for ethanol remained unusually high after cessation of infusion, a permanent change may take place in the central nervous system. central nervous system.
Alcohol Drinking↗
Effects of implantation site of stem cell grafts on behavioral recovery from stroke damage.
BACKGROUND AND PURPOSE: Findings that MHP36 stem cells grafted into intact parenchyma contralateral to the lesion induced by middle cerebral artery occlusion promoted recovery from stroke deficits led us to investigate whether implantation site of stem cells affects the functional efficacy of MHP36 grafts. METHODS: MHP36 cells (200 000/8 microL) were implanted in the left (n=8) or right (n=9) parenchyma or infused into the right ventricle (intraventricular; n=7) 2 to 3 weeks after stroke induced by 60 minutes of intraluminal right middle cerebral artery occlusion. Additionally, intact (n=11) and stroke (n=7) control groups were tested for 14 weeks in bilateral asymmetry, rotation bias, and spatial learning tasks before histological investigation of cell distribution and differentiation. RESULTS: Rats with left and right parenchymal grafts showed reduced bilateral asymmetry but no improvement in spatial learning. Conversely, spatial learning improved in rats with intraventricular grafts, but marked asymmetry persisted. No grafted group showed reduced amphetamine-induced rotation bias or reduced lesion volume relative to stroke controls. In all grafted groups, cells occupied both sides of the brain. A third of cells grafted in the striatum crossed the midline to occupy homologous regions in intact and lesioned hemispheres and differentiated into site-appropriate phenotypes. CONCLUSIONS: After stroke, both the intact and lesioned hemispheres attract grafted stem cells, suggesting repair processes that utilize cells both for local repair and to augment plastic changes in contralateral motor pathways. However, differential effects of parenchymal and intraventricular grafts suggest that different mechanisms are implicated in recovery from cognitive and sensorimotor deficits induced by stroke.
Animals↗
[Infusion test in the normal pressure hydrocephalus (author's transl)].
Continuous monitoring of the intracranial pressure and ventricular infusion test were carried out in 13 cases in which normal pressure hydrocephalus (NPH) was suspected. The infusion test was performed by intraventricular bolus injection of 8 ml of saline. The result was collated with the effect of shunting operation, which was judged by means of the improvement in the clinical symptoms and the amplitude of contingent negative variation. The excellent effect of shunting operation was obtained in the patients who showed the T of more than 200 sec, the compliance of less than 1.0 ml/mmHg, the conductance to outflow of less than 0.8 ml/mmHg/min and CSF outflow resistance of more than 15 mmHg/ml/min. In 3 cases out of the 5 effective cases, A or B wave was seen. However, appreciable variation of the values was shown among the cases so that it was concluded that the all-round-consideration must be done to select the case for the shunting operation with the findings in RI-cisternography, pneumoencephalography, computerized tomography and so on. This fact might indicate the existence of the complicated pathophysiology in NPH resulted from not only the impairment of cerebrospinal fluid circulation but also the disturbance of cerebral blood flow, changes in plasticity of the brain and so on.
Adult↗
Distribution of methotrexate in the cerebrospinal fluid and brain after intraventricular administration.
Explore the source record for details and available documents.
Animals↗
Successful treatment of ventriculostomy-related meningitis caused by vancomycin-resistant Enterococcus with intravenous and intraventricular quinupristin/dalfopristin.
We report a case of ventriculostomy-related meningitis caused by vancomycin-resistant Enterococcus faecium (VRE). The patient was successfully treated with administration of quinupristin/dalfopristin by both intravenous and intraventricular routes. A brief review of the literature is provided, which indicates that optimal management with quinupristin/dalfopristin should include daily intraventricular doses of at least 2 mg.
Drug Therapy, Combination↗
Tryptamines and some other substances affecting waking and sleep in fowls.
1 Adult fowls (Gallus domesticus) with cannulae chronically implanted in the IIIrd cerebral ventricle and various other sites of the brain, received infusions or injections of tryptamines and catecholamines into the brain; effects of and interactions between these substances on behaviour, electrocortical activity and body temperature were studied. Reserpine-induced arousal, was investigated in young and adult fowls. 2 Tryptamine and alpha-methyltryptamine, given intraventricularly or into the hypothalamus of intact fowls evoked behavioural and bilateral electrocortical arousal, postural changes, elevation of body temperature and tachypnoea; behavioural and bilateral electrocortical arousal were obtained with infusions into the mesencephalon. Ipsilateral electrocortical arousal only, resulted from infusion of alpha-methyltryptamine into the hypothalamus or mesencephalon of fowl encephale isole preparations. The above effects in intact fowls were reduced or replaced by sleep following administration of noradrenaline or alpha-methylnoradrenaline into the IIIrd ventricle or hypothalamus. Pretreatment of intact fowls with an amine oxidase inhibitor surprisingly attenuated or reversed the excitant effects of intraventricular tryptamine. 3 5-Hydroxytryptamine (hydrogen maleinate, creatinine sulphate or oxalate) given intraventricularly or infused into the hypothalamus, elevated body temperature; tachypnoea and postural changes developed at some stage during the elevation of body temperature. Sleep also was induced, although with the oxalate this was succeeded by marked arousal. 4 Behavioural and electrocortical sleep induced by 5-hydroxytryptamine infused into the hypothalamus were replaced by arousal on infusing tryptamine into the hypothalamus, and vice versa. 5 Dexamphetamine infused into the hypothalamus induced drowsiness or sleep which even reversed arousal elicited by systemically administered dexamphetamine. 6 Reserpine-induced arousal was achieved in young and adult fowls pretreated with mebanazine; this arousal was attenuated or replaced by sleep following intraventricular noradrenaline or dopamine but not by 5-hydroxytryptamine nor by noradrenaline or dopamine applied to the hypothalamus. Prenylamine also induced arousal following pretreatment of chicks with mebanazine.
Animals↗
A rodent model of infusion brain edema: methodology and pathophysiological effects of saline and protein infusions.
To evaluate the potency of putative secondary mediators of brain edema and their possible contribution to edema related brain dysfunction an infusion model of brain edema was developed in rats. 100 ul of fluid (saline, 20% nonautologous protein) was infused over one hour into the left forebrain white matter through a stereotaxically placed (+1.2 mm ant to bregma, 3 mm lateral and 2.9 mm depth) 25 G needle. Brain tissue hydraulic resistance (Rt), regional cerebral blood flow (rCBF), cortical somatosensory evoked potentials (SEPs) and intracranial pressure (ICP) (intraventricular needle) were monitored during the infusion and rCBF CO2 reactivity (hydrogen clearance), local brain water content (microgravimetry), BBB integrity (Evans Blue 2%) and brain histology (H & E. Solochrome-cyanin) were evaluated after the infusion. Saline infusates caused no physiological dysfunction despite ipsilateral expansion and vacuolation of the subcortical white matter, separation of axonal bundles and a significant decrease (p = 3.8 x 10(-5] in local subcortical tissue specific gravity. Cortical histology and specific gravity adjacent to the infusion locus were normal. Rt significantly decreased (p = 6.5 x 10(-4] during the infusion but there were only minor increases in ICP. Findings with 20% protein infusates were similar despite a focal 65% decrement in the rCBF CO2 reactivity adjacent to the infusion site. This study has shown that a simple and inexpensive model of infusion brain edema can be created in the rat and that it provides a useful model for assessing the physiological effects of mediator compounds in the infusate. Potential applications and methodological improvements for this model are discussed.
Animals↗
Intrathecal morphine tolerance: use of intrathecal clonidine, DADLE, and intraventricular morphine.
Explore the source record for details and available documents.
Adenocarcinoma↗
Pharmacokinetics of fluconazole in the cerebrospinal fluid of children with hydrocephalus.
BACKGROUND: The aim of this study was to examine the pharmacokinetics of fluconazole in the CSF of children with hydrocephalus during CNS infection treatment after intravenous and/or intraventricular drug administration. Direct fluconazole administration into the ventricular CSF of patients to treat serious CNS infections is an aggressive therapy, and data on the pharmacokinetics of fluconazole in CSF are limited. METHODS: A method of fluconazole quantification in CSF by solid-phase extraction (SPE)-high-performance liquid chromatography (HPLC) was developed to conduct pharmacokinetic studies. The population of patients included 2 children with hydrocephalus. Fluconazole was administered intravenously at average multiple doses of 12.5 mg/kg/24 h and intraventricularly at doses of 4, 5 and 7.5 mg/24 h, and 7.5 and 10 mg/12 h. The CSF samples were taken 2-24 h after administration of fluconazole. The concentrations of fluconazole in CSF specimens were assessed, and after pharmacokinetic studies the fluconazole dosage was modified. RESULTS: The method of fluconazole determination in CSF using the SPE-HPLC method is specific, precise and accurate. After intravenous fluconazole administration, the concentration of this antifungal drug was not detected in the ventricular CSF. The pharmacokinetic parameters determined after intraventricular fluconazole administration were: steady-state peak CSF fluconazole concentration (19.54 +/- 5.63 mg/l); trough CSF fluconazole concentration (0.0-0.3 mg/l); elimination rate constant (0.4654 +/- 0.2097 h(-1)), and half-life (1.84 +/- 0.93 h). CONCLUSIONS: The authors developed a method to determine fluconazole in CSF by SPE-HPLC. After intravenous fluconazole administration, the drug was not detected in the examined CSF samples. The intraventricular multidose pharmacokinetic data suggest the necessity of fluconazole monitoring in children with hydrocephalus during the treatment of shunt infection.
Adolescent↗
The effects of intraventricularly administered GABA and picrotoxin and their interactions on somato-vegetative reflexes in cats.
The effects of intraventricularly (third, fourth and lateral cerebral ventricles) applied GABA and picrotoxin on blood pressure and reflexogenic hypertension and nictitating membrane contractions after central sciatic nerve stimulation were studied in lightly anaesthetized cats. The interactions between both substances were also studied. It was shown that picrotoxin caused a strong elevation of blood pressure and a long lasting contraction of the nictitating membrane when infused into each part of the cerebral ventricular system. These effects of picrotoxin were antagonized by GABA. GABA inhibited the reflexogenic hypertension when given into the fourth ventricle and the reflexogenic nictitating membrane contractions given into the third and fourth ventricles. Picrotoxin antagonized the inhibitory effects of GABA on the reflexogenic nictitating membrane contractions. It is concluded that in the central regulation of some somato-vegetative reflexes the GABA-ergic transmitter system takes part.
Aminobutyrates↗
Safety of intraventricular sodium nitroprusside and thiosulfate for the treatment of cerebral vasospasm in the intensive care unit setting.
BACKGROUND AND PURPOSE: We have recently reported the safety of intraventricular sodium nitroprusside for the treatment of cerebral ischemia from vasospasm. Treatments have been accompanied previously by cerebral angiography to gauge treatment effect on established vasospasm. We presently report the safe coadministration of intraventricular sodium nitroprusside and thiosulfate in 10 patients with secured ruptured cerebral aneurysms in the intensive care unit, without the use of cerebral angiography for vasospasm treatment. METHODS: Patients were considered eligible for treatment on the basis of subarachnoid hemorrhage grade or manifestation of cerebral vasospasm by either transcranial Doppler ultrasonography (TCD) or neurological examination criteria. The route of administration was intraventricular, by way of ventriculostomy. Two separate protocols differing in dosage frequency were used, depending on the presence or absence of a new neurological deficit. Response to treatment was measured by TCD and neurological criteria. RESULTS: Good outcome was observed in 7 of 8 vasospasm patients presenting with clinical subarachnoid hemorrhage grade > or =3. Four patients demonstrated reversal of well-defined neurological deficits (hemiparesis, paraparesis) in the setting of treatment. Seven patients demonstrated a decrease in TCD velocities within 1 hour of treatment. Two patients died: 1 from intractable vasospasm despite maximal medical management and angioplasty and 1 from pulmonary causes. One episode of hypotension occurred in the setting of a high dose of medication. This responded promptly to medical management. Prolonged intracranial hypertension did not occur; modest elevations of both intracranial pressure and mean arterial blood pressure were observed when nausea and vomiting were associated with treatment, which occurred commonly in awake subjects. CONCLUSIONS: Intraventricular sodium nitroprusside with thiosulfate may be safely administered in the intensive care unit setting without the requirement of cerebral angiography to guide the effects of therapy.
Adult↗
Chronic intraventricular administration of cholecystokinin octapeptide (CCK-8) suppresses feeding in rats.
Cholecystokinin octapeptide (CCK-8) is known to suppress feeding in sheep, pigs, golden hamsters and rats following acute intracerebroventricular (i.c.v.) injection. In this study, we report the effects of chronically administered i.c.v. CCK-8 on long-term food intake in rats. After baseline food intake was established over a period of 3 days, rats were implanted with Alzet osmotic minipumps, which delivered 1.0 microliter/h. Three groups of animals were prepared which received saline (vehicle) or CCK-8 at 12.25 micrograms/day (low dose) or CCK-8 at 122.5 micrograms/day (high dose). Surgical preparation of the animals with the intraventricular cannula and the osmotic minipump resulted in an initial reduction in food consumption in all groups. In the saline group daily food consumption returned to presurgery values by day 4. Similar results were observed with the low dose of CCK-8. In contrast, in animals receiving the high concentrations of CCK-8, the initial fall in feeding was more prominent and though it rose during the 7-day infusion interval, it remained statistically below control during this period. After termination of the infusion, daily food consumption rose to normal levels during the next 3 days. For comparison, the cumulative difference between daily food consumption over the period of 8 days during infusion and pre-infusion control was 39.9 +/- 10.0 g/24 h in the saline group. In CCK-8-infused animals, food consumption after pump implantation was reduced by an integrated value of 35.5 +/- 5.0 g/24 h at low dose and 117.4 +/- 20.2 g/24 h at high dose.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Surgical shunt infection: significant reduction when using intraventricular and systemic antibiotic agents.
OBJECT: Infection represents the most common serious complication of shunt surgery, and typically its incidence ranges between 5 and 15%, despite the use of systemic antibiotic agents. Because systemic antibiotic medications generally penetrate the cerebrospinal fluid (CSF) poorly, the authors investigated, in a controlled study, whether the addition of intraventricular antibiotic treatment decreases the incidence of perioperative infection in adult patients. METHODS: Data pertaining to all CSF shunt procedures conducted at the authors' institution during an 11-year period were reviewed. Perioperative infection was defined as culture-positive CSF and the clinical presence of infection-related symptoms occurring within 90 days of surgery. All patients underwent intraoperative systemic antistaphylococcal antibiotic therapy. Before May 16, 1999, the senior author (R.H.S.) also administered 4 mg of gentamicin intraventricularly at surgery (Group I); thereafter, 10 mg of vancomycin was additionally administered (Group II). Other neurosurgeons at this institution did not use intraventricular antibiotic therapy, and their patients served as additional controls in identical time periods (Groups III and IV). A total of 802 shunt procedures were performed in 534 patients. Control infection rates were 5.4% (eight of 147) in Group I; 6.2% (nine of 145) in Group III; and 6.7% (18 of 267) in Group IV. With the combination of systemic antibiotic and intraventricular gentamicin and vancomycin (Group II), the infection rate fell significantly to 0.4% (one of 243). No complications were noted in association with intraventricular antibiotic administration. CONCLUSIONS: The combination of intraventricular gentamicin and vancomycin with systemic antibiotic therapy significantly decreased the incidence of perioperative shunt infection. It is presumed that intraventricular antibiotic therapy extends prophylactic antibiotic coverage into the CSF and prevents bacterial seeding.
Adolescent↗