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Accidental subcutaneous injection of elemental mercury. A case report.

Subcutaneous injection of elemental mercury is a very rare situation. The authors report the case of a 31-year-old man who accidentally injected an unknown quantity of metallic mercury into his left forearm. Several surgical procedures were required to reduce the blood and urinary levels of mercury. However, the patient never developed clinical signs of chronic poisoning. This observation confirms the lower risk of acute or chronic poisoning in subcutaneous injection of mercury and the need for early excision of contaminated tissue.

Accidents, Occupational↗

Subcutaneous injection of triamcinolone acetonide in the treatment of chronic vulvar pruritus.

OBJECTIVES: We studied the efficacy of subcutaneous corticosteroid injection as therapy for chronic vulvar pruritus. STUDY DESIGN: Adult women with symptoms of vulvar pruritus > 6 months were studied. After appropriate biopsies and cultures were performed, patients were included in the study group if they experienced limited relief with topical triamcinolone cream. Triamcinolone acetonide (15 to 20 mg) was injected subcutaneously and massaged into the affected vulvar tissue. RESULTS: Seventy-eight percent of patients (35/45) experienced relief of vulvar pruritus for > 1 month (mean duration 5.8 months). CONCLUSIONS: We found that subcutaneous injection triamcinolone acetonide provided relief of symptoms of chronic vulvar pruritus.

Adult↗

In vivo release of oxytetracycline from a biodegradable controlled-release gel injected subcutaneously in Japanese quail (Coturnix coturnix japonica).

A long-acting, biodegradable, controlled-release formulation of oxytetracycline (CR-OTC) was evaluated in 18 adult Japanese quail (Coturnix coturnix japonica) following a single subcutaneous (s.c.) injection. Prior to characterizing the release of oxytetracycline (OTC) from the CR-OTC, the pharmacokinetic parameters of intravenously (i.v.) administered OTC were determined. Concentrations of free OTC were measured using a bioassay. The plasma concentration-time profile of OTC after a single i.v. injection at 20 mg/kg was best fit to an open two-compartmental model, with the following pharmacokinetic parameters: area under the curve (AUC) = 36.72 mg. h/L, terminal elimination half-life = 2.34 h, clearance (Cl) = 0.545 L/kg/h. Plasma [OTC] was >1.0 micro g/mL for at least 4 h following i.v. injection. The CR-OTC gel was well tolerated at a dosage of 1500 mg/kg s.c. Plasma [OTC] rose to >1.0 micro g/mL within 24 h; it remained >1.0 micro g/mL for at least 10 days in all birds sampled at that time point (n = 9) and for at least 18 days in two of nine birds. Using a deconvolution technique, it was determined that approximately 54.8% of the administered OTC was released from the CR-OTC over the 45-day observation period. This long-acting, biodegradable controlled-release OTC formulation may have potential for the treatment of chlamydophila infections and other OTC-sensitive bacteria in Japanese quail, however further studies are necessary to determine its safety and clinical application.

Animals↗

Pharmacokinetics and metabolic effects of growth hormone injected subcutaneously in growth hormone deficient patients: thigh versus abdomen.

OBJECTIVE: The absorption of insulin following subcutaneous (s.c.) injection is faster in the abdomen than the thigh. We therefore studied the effect of changing the site of injection on the absorption and metabolic effects of human growth hormone. DESIGN AND MEASUREMENTS: In a cross-over study human GH (Norditropin) was injected s.c. in the thigh or abdomen in random order. Ultrasonography of the thigh and abdomen was performed in order to evaluate the thickness of the s.c. tissue. After each treatment period (4 weeks), serum profiles of GH, IGF-I, IGF binding proteins 1 and 3 (IGFBP-1 and IGFBP-3), glucose, insulin, non-esterified fatty acids (NEFA), glycerol, 3-hydroxybutyrate, alanine, lactate and glucagon were measured for 37 hours after GH injection (3 IU/m2 at 1900 hour). PATIENTS: Nine GH deficient patients (five males, four females). RESULTS: The mean (+/- SEM) thickness of the s.c. tissue (mm) was higher on the abdominal site (9.35 +/- 1.38 (thigh), and 22.61 +/- 2.19 (abdomen), P < 0.001). Mean (+/- SEM) integrated levels (area under the curves (AUC) divided by time) of GH (mU/l) were identical: 5.54 +/- 0.70 (thigh) versus 5.48 +/- 0.64 (abdomen) (P = 0.91). AUC (mU/l) for the initial 6 hours were, however, significantly different (14.10 +/- 3.76 (thigh) and 19.02 +/- 3.18 (abdomen), P = 0.02). Maximal serum concentration (Cmax) (mU/l) 23.18 +/- 3.86 (thigh) and 29.66 +/- 4.78 (abdomen) (P = 0.19) was achieved faster (Tmax) following injection in the abdomen. Tmax (hours) was 5.89 +/- 0.41 (thigh) and 4.26 +/- 0.49 (abdomen) (P < 0.002). Mean IGF-I levels (microgram/l) were unaffected by GH injection sites (355 +/- 60 (thigh) and 365 +/- 63 (abdomen), P = 0.61). Mean IGFBP-3 levels (microgram/l) were significantly different (2100 +/- 143 (thigh), and 2350 +/- 176 (abdomen), P = 0.05). Mean levels of IGFBP-1, insulin, glucose, lipid intermediates, metabolites and glucagon were not significantly different. CONCLUSIONS: Human GH was absorbed faster when injected s.c. in the abdomen as compared with the thigh, despite the thicker s.c. tissue on the abdomen. Apart from higher IGFBP-3 levels after s.c. injections in the abdomen, similar metabolic effects of GH were obtained with the two injection sites.

Abdomen↗