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[Intracavernous auto-injection therapy with papaverine phentolamine via an auto-injection pen for patients with an erectile dysfunction: similar results achieved in family practice and urology].

OBJECTIVE: To determine the results of an auto-injection therapy with papaverine-phentolamine (using an auto-injection pen) prescribed by a GP or a urologist, in patients with erectile dysfunction. DESIGN: Prospective, comparative, descriptive. METHOD: A total of 603 men with erectile dysfunction who were prescribed papaverine-phentolamine auto-injection by 59 GPs and 76 urologists participated in the study. The physician completed a questionnaire at the first visit and during the three follow-up visits (the last at 6 months) and the patient kept a diary and gave a satisfaction score on a nine-point scale. RESULTS: The cause of the erectile dysfunction was most commonly psychogenic/mixed somatic-psychogenic in the GP group and most commonly vascular in the urologist group (p > 0.05). The somatic comorbidity was the same (70%), whereas the prevalence of psychological symptoms differed (GP group: 6%; urologist group: 7%; p < 0.001). Attendance at all of the follow-up examinations was 38% for the GP group and 17% for the urologist group. The mean starting dose in the GP group was 0.49 ml and in the urologist group 0.70 ml (p < 0.001). The mean end dose was the same (about 1 ml). The frequency of adverse reactions was 9%: haematoma (5%), prolonged erection (1.8%). During the course of the investigation, 38% of the patients (31% in the GP group; 40% in the urologist group) discontinued the treatment owing to a limited effect, adverse reactions, difficult administration or problems related to the partner. In both the GP and the urologist group, 72% of the patients and 77% of the partners were satisfied or very satisfied with the auto-injection pen treatment. The patient's mean satisfaction score was 7.2. CONCLUSION: Whether the patient was treated by a GP or a urologist, the auto-injection therapy with papaverine-phentolamine for erectile dysfunction, using an auto-injection pen, was well tolerated and was highly appreciated by both the patients and their partners. Nevertheless one third of the patients discontinued the treatment prior to the end of the study. The mean end dose of the medication was the same in both groups.

Adrenergic alpha-Antagonists↗

Combination therapy of percutaneous mitoxantrone injection, percutaneous ethanol injection, and transcatheter arterial embolization for intrahepatic hepatocellular carcinoma and adrenal metastasis.

We treated a 63-year-old man who had recurrent large hepatocellular carcinomas (> 5 cm in diameter) and left adrenal metastasis with the combination approach of percutaneous intratumoral chemotherapy with mitoxantrone, percutaneous ethanol injection, and transcatheter arterial embolization. He received repeated transcatheter arterial embolization and percutaneous ethanol injection combination therapy for intrahepatic hepatocellular carcinomas, which controlled his disease for 6 months from the first treatment. After that, left adrenal metastasis was detected by biopsy specimen. Therefore, we repeated more transcatheter arterial embolization and percutaneous ethanol injection to the liver and left adrenal gland, but this combination therapy could not control the hepatocellular carcinomas in these organs. With the patient's consent, he was treated with the combination approach of percutaneous intratumoral chemotherapy with mitoxantrone, percutaneous ethanol injection, and transcatheter arterial embolization for hepatocellular carcinomas of the liver and left adrenal gland. After this combination therapy, we followed-up the viable lesions by color Doppler ultrasonography and computed tomography examination. However, we could not detect these viable lesions of hepatocellular carcinomas in his body until one month before he died. When the degree of hepatic failure worsened due to the natural course of cirrhosis, this combination therapy was stopped 7 months before he died. He died of pulmonary tumor emboli from metastasis of inferior vena cava 24 months after the combination therapy started. However, on autopsy there was almost no remaining hepatocellular carcinoma found in the main lesions of liver and left adrenal gland. We suggest that a combination approach of percutaneous intratumoral chemotherapy with mitoxantrone, percutaneous ethanol injection, and transcatheter arterial embolization may be indicated in elderly cases of intrahepatic large hepatocellular carcinoma and adrenal metastasis, which are not under control only by transcatheter arterial embolization and percutaneous ethanol injection.

Adrenal Gland Neoplasms↗

[Efficacy of simultaneous bolus injection of lidocaine with propofol on pain caused by propofol injection].

To investigate the effect of simultaneous bolus injection of 2% lidocaine 2 ml on preventing the pain on propofol injection, 80 patients were randomly assigned to one of four study groups; Group I received simultaneous bolus injection of 2% lidocaine 2 ml with infusion of propofol; Group II received bolus injection of saline 2 ml, 10 s before the start of infusion of propofol-lidocaine mixture; Groups III and IV received bolus injections of lidocaine and saline, separately 10 s before starting propofol infusion. Incidence of propofol-induced pain was significantly more frequent (P < 0.001) in Group IV (70%) than in the other groups (20% each). Number of patients who were satisfied with this anesthetic induction and requested for the same induction method in the next anesthesia was significantly larger in the groups receiving lidocaine (P < 0.05). Simultaneous bolus injection of lidocaine with propofol showed a similar clinical efficacy compared with both preadministration and premixing of lidocaine in preventing the propofol-induced pain.

Adult↗

[Ultrasound-guided renal cyst puncture and 95% ethanol injection. Part 1: Estimation of ethanol levels in the blood and urine following 95% ethanol injection].

Seventeen solitary renal cysts were punctured with the ultrasound-guided procedure and 26-91% of the cyst volume was replaced with 95% ethanol used as a sclerosing agent of the cyst wall. Ethanol was injected through a 7 F pigtail ureteral catheter, allowed to remain in place for 20 minutes and removed through the catheter. Recovery rate of ethanol was 82.4%. The maximum blood level of ethanol was obtained 30 to 60 minutes after injection, while the maximum urinary excretion rate was observed after 60 to 120 minutes. The maximum blood levels of ethanol ranged from 0.015 to 0.339 mg/ml. There was a positive correlation between injected volume of ethanol and the maximum blood level (r = 0.66) or the total amount of urinary excretion during 12 hours (r = 0.72). Residual ethanol concentrations in the body were calculated from injected volume and recovery rate of ethanol. Only 2.3% of the residual ethanol in the body was excreted in the urine during the first 12 hours after injection. However, urine/blood ratio of ethanol 1 hour after injection was tremendously high with a wide variation between 1.6 and 230.5. Therefore, a large part of the ethanol absorbed from the cyst wall seems to be excreted directly from the kidney, not entering general circulation. From the estimation of the blood and urine levels of ethanol, it is concluded that 95% ethanol can be applied to the renal cyst wall as a sclerosing agent through the percutaneous ultrasound-guided procedure in the case of good recovery of ethanol.

Adult↗

Compatibility of netilmicin sulfate injection with commonly used intravenous injections and additives.

The compatibility and stability of netilmicin sulfate in a concentration of 3 mg/ml in 37 intravenous injections and in 5% dextrose and 0.9% sodium chloride injection with 26 commonly used additives were studied. Compatibility between an intravenous administration set and selected admixtures were also evaluated. The admixtures were stored at 4 and 25 degrees C for seven days. After mixing and on days 1, 3, and 7, all admixtures were evaluated for netilmicin potency, pH, color, osmolarity, and clarity. A microbiological assay was used to measure netilmicin potency. No changes in netilmicin potency, pH, osmolarity, color, or clarity were observed in any of the 37 netilmicin sulfate admixtures. Similarly, no changes in pH, osmolarity, or clarity were seen in the admixtures of netilmicin sulfate with a second additive. Netilmicin activity was retained for seven days in 22 of the 26 admixtures with a second additive. Netilmicin sulfate in admixtures with multivitamin injection or vitamin B complex (Upjohn) was stable for only one day; with diphenhydramine hydrochloride or neostigmine methylsulfate, for only three days. No incompatibilities between the intravenous infusion set and admixtures of netilmicin sulfate were apparent. Netilmicin sulfate injection is compatible and stable for at least seven days stored at 4 and 25 degrees C when mixed in 37 intravenous injections, and when mixed individually with 22 additives in 5% dextrose and 0.9% sodium chloride injection.

Colorimetry↗

[Analysis of the failure of endoscopic treatment of vesico-renal reflux in children using injections of teflon and collagen and the preliminary results of injections of Macroplastic].

This study of 785 cases of vesicorenal reflux in 494 children treated endoscopically over a 7-year period was designed to evaluate the results obtained with three products used successively: Teflon, collagen and Macroplastic. Following Teflon injection, despite a 90% short-term success rate, recurrent reflux was subsequently observed in 16.71% of the ureters reviewed. The failure rate was 52.63% after collagen injection and 11.77% after Macroplastic. After one or two injections, complete resolution of reflux was obtained in 48% of children treated with collagen, versus 85.72% with Teflon and 93.33% with Macroplastic. In one half of cases, failure was related to the quality of the product and its modifications after injection. The marked resorption of collagen accounts for the poor results despite the large doses injected. Apart from one case of partial resorption of Teflon paste, the failures with this product were due to lateralisation or secondary elimination of the product from the injection site due to its fluidity. Macroplastic, due to its higher viscosity and absence of retraction, currently provides the best results with doses of less than 0.20 ml in children.

Anuria↗

[Effects of intravenous injection of ioversol, a nonionic contrast medium, on circulating blood volume: comparison among different combinations of its dose and volume injected].

Effects on circulating blood volume (CBV) of the intravenous injection of a nonionic contrast medium, ioversol, with various doses were assessed in order to find a way of injection with less effects on systemic circulation. Ioversol was injected as a bolus to 20 mongrel dogs at doses of A: 3.75 ml/kg (n = 8) or B: 2 ml/kg (n = 6) of a solution containing 320 mg iodine per ml, or C: 2 ml/kg (n = 6) of a 240 mgI/ml solution. Colloid oncotic pressure (COP) of the bloods drawn before and 1, 2, 3, 5 min after the injection of ioversol was measured by a needle type osmometer, and changes in CBV were calculated using the COP values. Upon injection of ioversol CBV increased rapidly and then gradually returned to the preinjection levels. The change in CBV induced by ioversol was significantly less than those reportedly induced by an ionic contrant medium, iothalamate, and a nonionic medium, iopamidol, and comparable to that by another nonionic medium, iohexol. The degree of increase in CBV and the blood concentration of ioversol were related to the amount, but not the volume, of ioversol injected. Thus, ioversol proved to be one of the low osmotic nonionic contrast media with less effects on CBV. Furthermore, it is suggested that the amount, rather than volume, of contrast medium should be taken into consideration when the angiography of the patients with reduced cardiac function, children or aged patients is performed in whom the contrast medium-induced CBV expansion needs to be as less as possible.

Animals↗

Compliance and use behaviour, an issue in injectable as well as oral contraceptive use? A study of injectable and oral contraceptive use in Johannesburg.

This study examines the compliance, use behaviour and knowledge of method of women using injectable and oral contraceptives in two clinic sites in the Johannesburg area, South Africa. An interviewer administered questionnaire was used to collect information in the clients' home language. A total of 400 women were interviewed in the clinics. The mean age of clients was 26.2 years (range 13 to 43 years). Of the clients not wanting to get pregnant, 30.4 per cent of injectable users and 18.4 per cent of oral contraceptive (OC) users had stopped using their method temporarily before returning to the same method (called the nonuse segment) and had not used any other form of contraception during this time. Almost one third of injectable users (31.2 per cent) had been late for their next injection at least once. Although nearly all women using injectables had experienced some menstrual disturbances, over one third (38.5 per cent) had not been informed by the providers about the possibility of these changes. Many women gave the disruption of their menstrual cycle as the reason for the nonuse segment. The majority of OC users lacked information on how to use their method correctly. Nearly all women expressed an interest in obtaining more information on their current method and other available methods. This study shows that compliance is an issue in injectable as well as OC users.

Adolescent↗

Delayed first injection of the once-a-month injectable contraceptive containing 25 mg of medroxyprogesterone acetate and 5 mg of E(2)-cypionate: effects on ovarian function.

OBJECTIVE: To assess whether women who were administered the first injection of DMPA+E(2)C on day 7 of their menstrual cycle (delayed injection) exhibit the same degree of ovarian suppression as women who receive it on day 5 of their menstrual cycle. DESIGN: Multicenter, randomized controlled trial. SETTING: Reproductive health clinics. PATIENT(S): Women aged between 18 and 38 years (inclusive) willing to use DMPA+E(2)C as their method of contraception. INTERVENTION(S): Participants received a DMPA+E(2)C injection on day 5 (control group, n = 41) or day 7 (delayed-injection group, n = 117) of their menstrual cycle. MAIN OUTCOME MEASURE(S): Ovarian activity and follicular development determined by serial serum progesterone levels and vaginal ultrasound. RESULT(S): Participants who received DMPA+E(2)C on day 5 of their menstrual cycle (control group) exhibited no more than limited follicular growth (no follicle >16 mm). Of those women who received DMPA+E(2)C on day 7 of their menstrual cycle (delayed-injection group), 21 (18%) showed some follicular growth, of whom 4 (3%) ovulated. CONCLUSION(S): The first injection of DMPA+E(2)C given on day 7 of a menstrual cycle does not provide the same inhibition of ovarian activity as that observed when it is administered on day 5 of the menstrual cycle.

Adolescent↗

Prevalence of serologic markers of HBV, HDV, HCV and HIV in non-injection drug users compared to injection drug users in Gran Canaria, Spain.

Injection drug use (IDU) is one of the most significant risk factors for viral hepatitis (B, D and C) and human immunodeficiency virus (HIV) infection. However, there is little information about the risk of infection among non-injection drug users (non-IDUs). The present study was designed to perform several objectives: (a) to evaluate the prevalence of serological markers of hepatitis B, D, C virus and HIV in IDU and non-IDU patients; (b) to compare the prevalence of these markers between both groups; (c) to identify risk factors for HCV and HIV in this population; and (d) to correlate the presence of HCV and liver function. A total of 385 consecutive patients (122 IDUs and 263 non-IDUs), admitted to the Drug Dependency Treatment Unit at the Hospital Insular of Gran Canaria between 1993 to 1994, were included in the study. The serological markers of HBV, HDV, HCV and HIV were determined by ELISA and immunoblot methods. In all cases we also measured syphilis tests (RPR and FTAabs), serum aminotransferases and serum gammaglutamiltranspeptidase. Compared to the non-IDU, the IDU group presents a higher prevalence of antiHBc (55.0% vs. 20.7%, p < 0.0001), antiHCV (87.6% vs. 35.3%, p < 0.0001) and antiHIV (21.8% vs. 2.7%, p < 0.0001). There was no significant difference in RPR positivity (0.9% vs. 4.9%, p = 0.06). Delta infection was only detected in injection drug users, and the prevalence was low. Using logistic regression, the only risk factors associated with antiHCV positivity were injection drug addiction (OR: 9.2, 95% CI: 4.9-17.0) and antiHBc positivity (OR: 5.5, 95% CI: 3.0-9.9). Similarly, the associated risk factors for HIV were injection drug addiction (OR: 5.9, 95% CI: 2.3-15.0) and antiHBc positivity (OR: 3.8, 95% CI: 1.5-9.2). However, no correlation was found between antiHCV positive and antiHIV or between these markers and RPR positivity. Patients positive for antiHCV showed significant elevations in aspartate aminotransferase and alanine aminotransferase levels, when compared with patients negative for antiHCV: 65.0 vs. 39.2 U/l (p < 0.001) and 88.4 vs. 40.3 U/l (p < 0.001), respectively. We conclude that drug users have an elevated prevalence of HCV, HBV and HIV infection, even if drug use is only inhalated. On the other hand, the main risk factors associated with HCV and HIV are injection drug addiction and exposure to hepatitis B virus. Finally, in the study population, liver dysfunction is closely related to HCV infection.

Adolescent↗

Thermodilution cardiac output. Cold vs room temperature injectate and the importance of measuring the injectate temperature in the right atrium.

BACKGROUND: The feasibility of thermodilution cardiac output measurements with the more convenient room temperature thermal indicator instead of cold injectates has been repeatedly investigated. However, the issue has not been addressed with the appropriate statistical approach advocated by Altman and Bland. Furthermore, we wished to determine if the incorporation of a second thermistor in the thermodilution catheter, to measure the temperature of the thermal indicator where it is delivered into the right atrium/superior caval vein, would result in more precise cardiac output measurements. METHODS: Fifty patients were randomized to receive a single or dual thermistor pulmonary artery thermodilution catheter. Cardiac output was calculated as the average of four injections of 10 ml of isotonic saline. Precision (2 x SD of differences in replicate measurements) for the two catheters and injectate temperatures, and bias and limits of agreement between measurements, with cold and room temperature injectates, were determined. RESULTS: Precision was (0 degrees C) 0.42 l/min and (20 degrees C) 0.90 l/min, and bias and limits of agreement -0.83 l/min and -1.93-0.27 l/min for the single thermistor catheter. For the dual thermistor system precision was (0 degrees C) 0.34 l/min and (20 degrees C) 0.58 l/min. Bias and limits of agreement were -0.03 l/min and -0.61-0.55 l/min. CONCLUSION: The second thermistor is redundant if cold injectates are used. If one wishes to use room temperature injectates the single thermistor system is inadequate. A dual thermistor catheter is, on the other hand, acceptable.

Adult↗

First injection and current risk factors for HIV among new and long-term injection drug users.

The purpose of this paper is to estimate HIV seroprevalence and to examine the injection and sexual risk behaviours of a cohort of active new heroin injectors who have initiated injection within the past four years and to compare their risk behaviours with those of long-term heroin injectors who initiated injection prior to January 1, 1985. A stratified network-based sample was used to recruit injection drug users (IDUs) from the streets of Miami-Dade, Florida. New IDUs displayed a significantly lower HIV seroprevalence than long-term injectors (13.3 versus 24.7%). Both new and long-term drug injectors exhibited a high level of current HIV risk behaviour. While new injectors were more likely than long-term injectors to practise safer injection behaviours at the initial injection episode, the current risk behaviours of new and long-term injectors are similar.

Adult↗

Two essential steps for a successful intracytoplasmic sperm injection: injection of immobilized spermatozoa after rupture of the oolema.

A total of 740 cycles of intracytoplasmic sperm injection (ICSI) were performed: 625 cycles when < 6 x 10(5) total motile spermatozoa were harvestable from the ejaculate and 115 cycles in cases with a history of previous fertilization failure after classic in-vitro fertilization or subzonal sperm injection. An average of two pronuclei were observed in 63% of the injected oocytes, allowing 725 transfers of a maximum of three embryos (98%). Of 214 pregnancies initiated, 179 were established (25% of ICSI attempts). Because the fertilization rates from our initial 80 ICSI cycles were 2-fold less than those achieved previously, we changed the injection procedure and analysed, in 740 ICSI attempts, the importance of interfering technical factors and how to establish a successful ICSI programme. A remarkable change in the fertilization rate up to 68% (595 cycles) occurred when two steps in the injection procedure were performed well, i.e. immobilization of the spermatozoon and placement of the spermatozoon into the ooplasm after cytoplasmic aspiration into the pipette until oolema rupture. This immobilization, by touching the tail with the pipette, is mandatory for increasing the percentage of fertilization, even with totally non-motile spermatozoa (41%). Because aspiration of the cytoplasm is an invasive part of the ICSI procedure and influences the quality of the embryos, it is essential to reduce the amount of cytoplasm drawn into the pipette. This could be attained by using a spikeless injection pipette with the smallest possible internal diameter.

Cytoplasm↗