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Enhanced sensitivity of mdx mice to intramuscular injection of compound 48/80.

Species-specific differences in the inflammatory response, specifically with regard to mast cells, have been proposed to explain the phenotypic variation among dystrophin-deficient humans, and mdx mice (Gorospe et al., 1994). To test this hypothesis we have intramuscularly injected a mast cell secretogogue into both dystrophin-negative mdx and dystrophin-positive normal mice. Mast cell activity was determined by measuring the activity of mast cell tryptase, while creatine kinase activity was used to determine the course of muscle damage in vivo. Area of damage around the injection site was measured at autopsy, and used as an indication of relative sensitivity to the secretogogue effect of compound 48/80. Mdx mice exhibited more damage in response to intramuscular injection than normal control mice. In addition, mdx mice showed a substantial increase in plasma tryptase activity, followed by a large increase in muscle creatine kinase activity. On the other hand, dystrophin-positive normal controls injected with 48/80 liberated little CK or tryptase activity. These results are consistent with the hypothesis that species-specific differences in mast cell activity, or sensitivity to mast cell products could account for the variation in pathology seen in dystrophin-deficient animals.

Animals↗

Coronary thrombolysis with facilitated absorption of intramuscularly injected tissue-type plasminogen activator.

Conventional activators of the fibrinolytic system used for coronary thrombolysis entail unavoidable delay, risk of bleeding, or both in contrast to tissue-type plasminogen activator (t-PA). Because the potential benefit of coronary thrombolysis is inversely related to the duration of antecedent ischemia, this study was performed to develop an approach for facilitated absorption of intramuscularly injected t-PA potentially adaptable for prompt, self-medication. In rabbits, absorption was markedly potentiated by hydroxylamine hydrochloride and electrical stimulation at the injection site. Intramuscular administration of t-PA in doses of 1 mg/kg of body weight, comparable to amounts given intravenously to patients (0.5-0.75 mg/kg), elicited peak blood levels of 431 +/- 52 (SEM) ng/ml 5 min after injection, well within the therapeutic range. In dogs, absorption facilitated by hydroxylamine promptly elicited angiographically documented coronary thrombolysis as well. The approach developed should ultimately permit prompt coronary thrombolysis and enhanced salvage of jeopardized ischemic myocardium in patients with life-threatening coronary thrombi.

Animals↗

Use of an in vitro model for the assessment of muscle damage from intramuscular injections: in vitro-in vivo correlation and predictability with mixed solvent systems.

The potential of binary mixtures of propylene glycol-water, ethanol-water, and polyethylene glycol 400-water to cause skeletal muscle damage (myotoxicity) following intramuscular injection was examined with an in vitro model using the isolated rat muscle. At moderate concentrations (20-40%, v/v) of the organic cosolvent, the order of myotoxicity was propylene glycol greater than ethanol much greater than polyethylene glycol 400. The in vitro results were then compared with in vivo toxicity in rabbits after injection of normal saline, 40% (v/v) polyethylene glycol 400, 40% (v/v) propylene glycol, indocyanine green in normal saline, and indocyanine green in 40% (v/v) propylene glycol. Employing the area under the creatine kinase activity curve from 0 to 72 hr as the index of skeletal muscle damage, an excellent in vitro-in vivo correlation was observed. The basic myotoxicity relationships obtained from the binary cosolvent systems were then used to examine the myotoxicity of ternary organic cosolvent mixtures. Several mixed solvent systems with the same theoretical molar solubilization power for a model compound, diazepam, were selected to determine (1) if myotoxicity can be reduced by changing the composition of the ternary mixtures and (2) if myotoxicity of the individual components is additive. For the solvent systems containing propylene glycol, ethanol, and water, the total myotoxicity equaled the sum of the individual myotoxicity of each component. In contrast, for the solvent systems containing polyethylene glycol 400, the total myotoxicity was only half of the sum of individual toxicities. These results suggest that polyethylene glycol 400 in mixed cosolvent systems might have a protective effect on the myotoxicity generated by intramuscular injections.

Animals↗

Suprofen kinetics in healthy male volunteers after intramuscular injection of increasing dosages.

Kinetics of alpha-methyl-4-(2-thienyl-carbonyl)-phenylacetic acid (suprofen, Suprol) a non-narcotic antiphlogistic analgesic, were studied in two clinical experiments. In a bioavailability study (study A) suprofen, given as intramuscular injection was absorbed more rapidly (mean peak plasma time 20.0 min) than from the capsule formulation (mean peak plasma time 57.5 min). With respect to the amount systemically absorbed, measured as area under the plasma concentration-time curve, both dosage forms were equivalent. Individual plasma concentration profiles (study B) were described by a 2-compartmental model with a mean first order absorption rate of 0.095 min-1, a rapid mean disposition rate alpha of 0.025 min-1 and an apparent terminal plasma elimination rate beta of 0.004 min-1. There was dose-independent kinetics and a linear correlation between peak plasma concentration versus dose and area under the curve (AUC) versus dose after intramuscular injection of suprofen up to 200 mg, leading to dose proportional bioavailability data.

Adult↗

Isofenphos poisoning: prolonged intoxication after intramuscular injection.

We report a unique case of attempted suicide by intramuscular injection of the organophosphate isofenphos which resulted in a muscarinic and nicotinic syndrome lasting 15 days and requiring prolonged mechanical ventilation and hospitalization. The patient, who demonstrated no signs of delayed polyneuropathy on hospital day 25, subsequently died of pneumonia. Toxicological investigations showed isofenphos plasma decay and confirmed the intramuscular route of poisoning. We believe continuous isofenphos absorption resulted in the prolonged intoxication observed in this patient.

Aged↗

The effect of environmental temperature on immune response and metabolism of the young chicken. 1. Effect of intramuscular injection on heat production.

The effect of intramuscular (IM) injection, per se, on heat (H) production was investigated in ad libitum- and restricted-fed pullets held at normal (21 C) and low (10 C) environmental temperatures. At 21 C IM injection, per se, decreased H-production of ad libitum- and restricted-fed pullets for 2 to 4 hr after injection. This effect was significant (P less than .01) in ad libitum-fed pullets, held at 21 C as well as at 10 C. Thus, when studying the effect of an immune response on the energy metabolism, an effect may be confounded with the effect of the IM injection per se when the measurements are made during the first 2 to 4 hr following injection.

Animals↗

Plasmid DNA malaria vaccine: the potential for genomic integration after intramuscular injection.

Plasmid-based (naked DNA) genetic vaccines are now entering clinical trials to test their safety and efficacy in healthy human volunteers. A safety concern unique to this new class of vaccines is the potential risk of deleterious integration into host cell genomic DNA following direct intramuscular injection. To address this issue experimentally, a preclinical safety study was conducted in mice to determine the structural nature of plasmid DNA sequences persisting in total muscle DNA at both 30 and 60 days following a single intramuscular injection of a plasmid expressing the Plasmodium falciparum circumsporozoite protein. In a protocol described for the first time, total DNA was extracted from muscle tissue and was subsequently linearized with a restriction endonuclease to enable agarose gel size fractionation of all extrachromosomal plasmid DNAs from high molecular weight mouse genomic DNA. Using PCR assays to quantitate plasmid-specific sequences, it was found that the amount of plasmid DNA persisting in muscle tissue varied but averaged about 10 fg per microgram of genomic DNA (in the range of 1500 copies per 150,000 genomes). In two of four separate experimental injections of mouse muscle, PCR assays of genomic DNA fractions indicated that agarose gel purification removed plasmid DNA down to a level of < or =3 copies per 150,000 mouse genomes. In the two other experimental samples, 3-30 copies of plasmid DNA remained associated with purified genomic DNA. The time following injection (i.e., 30 or 60 days) was not a factor in the number of copies of plasmid associating with genomic DNA and it was not possible to conclude if such sequences were covalently linked to genomic DNA or simply adventitiously associated with the genomic DNA. However, if an assumption is made that the highest level plasmid DNA found associated with genomic DNA (i.e., 30 copies) represented covalently integrated plasmid inserts and that each insert resulted in a mutational event, the calculated rate of mutation would be 3000 times less than the spontaneous mutation rate for mammalian genomes. This level of integration, if it should occur, was not considered to pose a significant safety concern.

Animals↗

Intramuscular injections of iron compounds and oncogenesis in man.

To evaluate the evidence for iron compounds as local carcinogens in man, histological material and clinical reports have been reviewed in seven of the eight published cases of tumours developing at the site of intramuscular injections. The microscopical appearances suggested benign lesions in two cases and a variety of tumours in the other five. In only two cases (a rhabdomyosarcoma and a fibrosarcoma) was the interval between injections and tumour development longer than six years. Of the remaining three tumours, one was considered to be a rather slowly growing haemangiopericytoma (with an interval of two years), one appeared to be a subcutaneous lymphoma with no evidence of having arisen in the gluteal muscles, and one was a pleomorphic sarcoma with a possible five-year interval. Sarcomas induced experimentally by iron compounds differ in being less variable in type and in containing abundant iron-containing macrophages, which were negligible in these human tumours.Although the total number of patients who have received intramuscular injections of iron compounds is not known, the present findings, in contrast to experimental work, do not support the view that such treatment carries a strong risk of tumour development.

Adolescent↗

Intramuscular injection of an adenoviral vector expressing hepatocyte growth factor facilitates hepatic transduction with a retroviral vector in mice.

Retroviral vectors can result in therapeutic and stable levels of expression of proteins from the liver. However, most retroviral vectors transduce only dividing cells, and hepatocytes are normally quiescent. The goal of this study was to determine if an adenoviral vector could transiently express hepatocyte growth factor (HGF) in order to induce hepatocyte replication and facilitate retroviral vector transduction of the liver. Intramuscular injection of an adenoviral vector that expressed human HGF from the cytomegalovirus promoter (Ad.CMV.HGF) resulted in moderate levels of HGF in blood and liver, and replication of 3 to 12% of hepatocytes. No cytopathic effect was observed in the liver, and a control adenoviral vector induced no or lower levels of replication. When a retroviral vector expressing beta-galactosidase cDNA was injected into a peripheral vein during the peak period of hepatocyte replication induced by intramuscularly administered Ad.CMV.HGF, 8% of hepatocytes were transduced. We conclude that intramuscular injection of Ad.CMV.HGF is a safe and effective way to induce transient systemic expression of HGF and hepatocyte replication, and to facilitate transduction of hepatocytes with a retroviral vector.

Adenoviridae↗

[Hip paraosteoarthropathy after sciatica nerve injury by quinine intramuscular injection].

INTRODUCTION: Often occurring in central nerve injuries, paraosteoarthropathic conditions are revealed by a stiffness or ankylosis of the joint. Their occurring during peripheral nerve injuries is rare. OBJECTIVE: To report a case of hip paraosteoarthropathy features after sciatica nerve injury by quinine intramuscular injection. MATERIALS AND METHOD: We report a case of a 24-year-old patient presenting with pain, oedema of the left buttock, limitation of bending of the left hip, and antalgic limping associated with a small step because of axonal left sciatic nerve injury. Initial pelvis X-ray and laboratory findings were normal. Reviewed 4 months later with important stiffness of the left hip, a second X-ray showed an atypical paraosteoarthropathy (POA). Chemotherapy and physiotherapy alleviated neurological muscle weakness but did not have any effect on the hip functionality. Surgical excision was the only treatment that improved the amplitude of movements. Evolution 7 years later showed the disappearance of the peripheral nerve-injury signs and the conservation of the movement amplitude obtained after excision, without a return to normal. CONCLUSION-DISCUSSION: Factors pointing to this POA were initial oedema, immobilization because of pain, and trauma by quinine intramuscular injection. The interest is the exceptional occurrence of POA on a peripheral nerve injury (sciatica nerve injury by quinine injection) outside the context of length resuscitation and that sciatica nerve injury is frequent in tropical countries but anachronistic in a developed one.

Adult↗

Optimal technique for intramuscular injection of infants and toddlers: a randomised trial.

OBJECTIVE: To compare the rates of adverse reactions and parental approval ratings for three different techniques for anterolateral thigh vaccination in children aged 2, 4, 6 and 18 months. DESIGN: Randomised, observer-blind trial. PARTICIPANTS: 375 children who received pertussis-containing vaccines in a regional New South Wales town between 29 May 2001 and 30 June 2002. INTERVENTIONS: Children were randomised to receive intramuscular injection with acellular pertussis-containing and Haemophilus influenzae type b vaccines with one of three recognised injection techniques (Australian, World Health Organization or United States). MAIN OUTCOME MEASURES: Local adverse reactions (bruising and redness/swelling), systemic adverse reactions (irritability, perceived fever, persistent crying/screaming, drowsiness, vomiting/poor feeding) and parental acceptance were assessed 24 hours after injection. RESULTS: 361 children (96%) were evaluated 24 hours after vaccination. The WHO technique resulted in significantly fewer children, than with the other two techniques, with the systemic adverse reaction variable "irritability" (P = 0.0039). There was a significant difference between the technique groups overall for the local adverse reaction "bruising" with acellular pertussis-containing vaccines (P = 0.0418), due to a lower reaction rate in the WHO group compared with the US group (P = 0.0356). CONCLUSION: The WHO technique appears to be the optimal technique for anterolateral thigh injection in children--it ensures that the injection is intramuscular, results in fewer adverse reactions, and is the easiest technique to perform as it does not require angling of the needle to the long axis of the femur.

Age Factors↗

Sublingual epinephrine tablets versus intramuscular injection of epinephrine: dose equivalence for potential treatment of anaphylaxis.

BACKGROUND: Epinephrine autoinjectors are underused in the emergency treatment of anaphylaxis in the community, perhaps in part because of fear of needles. OBJECTIVES: To determine the sublingual epinephrine dose from a novel fast-disintegrating tablet required to achieve epinephrine plasma concentrations (EPPCs) similar to those obtained after epinephrine 0.3 mg intramuscular injection. METHODS: In a prospective 5-way crossover study, sublingual tablets containing epinephrine 0, 10, 20, and 40 mg, and epinephrine 0.3 mg intramuscular in the thigh (EpiPen) were compared in a validated rabbit model. Blood samples were collected before dosing and 5, 10, 15, 20, 30, 40, 60, 90, 120, 150, and 180 minutes afterward. EPPCs were measured by using high-performance liquid chromatography-electrochemical detection. Pharmacokinetic parameters were calculated by using WinNonlin. RESULTS: The area under the curve (AUC), maximum concentration (C(max)), and time at which C(max) was achieved (T(max)) did not differ significantly (P > .05) after epinephrine 40 mg (AUC = 1861 +/- 537 ng/mL/min, C(max) = 31.0 +/- 13.1 ng/mL, and T(max) = 9 +/- 2 minutes) and epinephrine 0.3 mg intramuscular (AUC = 2431 +/- 386 ng/mL/min, C(max) = 50.3 +/- 17.1 ng/mL, and T(max) = 21 +/- 5 minutes). The AUC after tablets containing epinephrine 0 mg (AUC = 472 +/- 126 ng/mL/min), epinephrine 10 mg (AUC = 335 +/- 152 ng/mL/min), and epinephrine 20 mg (AUC = 801 +/- 160 ng/mL/min) did not differ significantly from each other, but were significantly lower (P < .05) than the AUC after epinephrine 0.3 mg intramuscularly. CONCLUSION: Sublingual administration of epinephrine 40 mg from this tablet formulation resulted in EPPCs similar to those obtained after epinephrine 0.3 mg intramuscular injection in the thigh. CLINICAL IMPLICATIONS: For treatment of anaphylaxis in the community, self-injectable epinephrine is underused. This novel, fast-disintegrating epinephrine tablet formulation for sublingual administration is a feasible alternative that warrants further development.

Administration, Sublingual↗

Enhancer and promoter chimeras in plasmids designed for intramuscular injection: a comparative in vivo and in vitro study.

Enhancers and promoters from various muscle-specific genes were substituted for or combined with the enhancer/promoter of the human cytomegalovirus (CMV) IE gene in a luciferase reporter gene plasmid in an effort to identify new promoter chimeras with increased expression activity after direct intramuscular injection. The regulatory sequence substitutions or additions varied in content, location, and orientation relative to the CMV regulatory sequences. The expression activities of the derivative and parent plasmids were compared quantitatively in vivo using a standard mouse intramuscular injection assay, and in vitro by transfection of differentiated C2C12 mouse myoblasts and BHK hamster kidney cells, to test whether cultured cell transfection could substitute for at least some animal experimentation. In vivo, 1 of 19 of the enhancer/promoter chimeras increased expression levels. In vitro, some chimeras showed significant expression augmentation in C2C12 cells, but not in BHK cells. We conclude that because of differences in plasmid expression profiles, these cell culture systems cannot readily substitute for in vivo testing of new plasmid constructs.

Animals↗

Midtrimester abortion induced by serial intramuscular injections of 15(S)-15-methyl-prostaglandin F2alpha.

Midtrimester abortion was successfully induced in 35 patients by serial intramuscular injections of 15(S)-15-methyl-prostaglandin F2alpha. The dose schedule in this series was an initial injection of 250 mug of 15-ME-PGF2alpha followed by another 250 mug in 2 hours, then 500 mug every 2 hours up to 24 hours; in patients who did not abort within 24 hours the dose was raised to 750 mug every 2 hours until abortion. The mean abortion time was 15.98 hours in this series and 86 per cent of the patients aborted in under 24 hours. Parous patients aborted faster (mean 14.81 hours) than nulliparous patients (mean 17.02 hours) and patients with lower gestational age, 13 to 16 weeks, aborted more quickly (mean 13.98 hours) than patients with gestational age 17 to 20 weeks (mean 16.35). These differences in this series, however, were not statistically significant. Gastrointestinal side effects occurred in 32 of the 35 patients and eight patients had a temperature elevation of more than 1 degree F. during the treatment period. The mean estimated blood loss was 137 plus or minus 42 ml. Thirty patients passed the fetal-placental unit intact, the placenta was removed by sponge forceps in three patients, and by surgical intervention in two patients. There were no failures of technique in this study and none of the patients developed endometritis.

Abortifacient Agents↗

Morphine: continuous intravenous infusion versus intramuscular injections for postoperative pain relief.

Postoperative pain was controlled in 42 patients with either continuous intravenous (iv) or scheduled intramuscular morphine following surgery for gynecologic cancers. In this double-blind study, no statistical differences were found in pain control or rate of complications between the two methods of administration. Both routes were effective in controlling pain without producing major toxicity. Initial doses were based on the patient's weight and then adjusted every 4 hr. We conclude that both methods are safe and effective but that continuous iv infusion is the preferred route because of the ease of administration, elimination of multiple intramuscular injections, and possibly more even pain control.

Adult↗

Pharmacokinetics of benzathine penicillin G: serum levels during the 28 days after intramuscular injection of 1,200,000 units.

Because of published data suggesting the inadequacy of once-every-4-weeks intramuscular injections of benzathine penicillin G for secondary rheumatic fever prevention, serum penicillin levels were determined at 1, 3, 10, 21, and 28 days after administration of 1,200,000 units of this repository penicillin. A total of 193 samples were studied. Mean serum penicillin levels remained greater than or equal to 0.02 micrograms/ml for 21 days, but by 28 days only 44% of the serum samples had detectable levels of penicillin and only 36% had levels greater than or equal to 0.02 micrograms/ml. Patients weighing more than 45 kg had significantly lower serum penicillin levels than did those who weighed less. There were similar correlations with body surface area and with age. These data indicate that a significant percentage of patients receiving benzathine penicillin G prophylaxis for prevention of recurrent attacks of rheumatic fever are not protected during the fourth week. More frequent administration of benzathine penicillin G should be considered in instances of high risk of recurrence of rheumatic fever.

Adolescent↗

Total and free ketoprofen in serum and synovial fluid after intramuscular injection.

Free and total ketoprofen levels in serum and synovial fluid were determined in 37 patients after a single intramuscular injection of ketoprofen, 100 mg. Free drug was separated by equilibrium dialysis. Ketoprofen was assayed by HPLC. Ketoprofen penetrated into the joints rapidly and significant concentrations were found at 15 minutes. The equilibrium time was about 3 1/2 hours. The AUC for total ketoprofen was greater in serum than in synovial fluid. On the other hand, the free fraction AUC in the serum and synovial fluid were quite similar. The mean residence time in the joint was about three times that in the systemic circulation. Ketoprofen was strongly bound to proteins and the percentage of free ketoprofen was not significantly different between serum and synovial fluid. These results provide a possible explanation for duration of the therapeutic effect of ketoprofen despite the short elimination half-life from the serum.

Adolescent↗

Superselective embolization of superior gluteal artery pseudoaneurysms following intramuscular injection: case report.

Two bleeding superior gluteal artery pseudoaneurysms occurred in a patient with advanced malignant disease following an intramuscular injection. This was diagnosed by angiography and successfully managed by superselective embolization. This avoided further surgery and no additional complication from the pseudoaneurysm occurred up to the time of the patient's demise.

Aneurysm↗