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1

Intravenous insulin infusion in diabetic emergencies.  

Science.gov (United States)

Continuous intravenous insulin and dextrose infusions were used in managing various diabetic emergencies. Standard and constant rates of insulin and dextrose infusion resulted in satisfactory control of blood glucose concentrations during labour, after major surgery, and in patients recovering from ketoacidosis (average insulin infusion rates 1, 2, and 3 U/h respectively). Higher infusion rates were used to correct or prevent ketoacidosis in pregnant diabetic women who had received steroids and sympathomimetic agents. The infusion method is simple, reliable, and flexible, and may help to simplify management of diverse types of diabetic emergencies. PMID:102400

Leslie, R D; Mackay, J D

1978-11-11

2

Potential life-threatening variations of drug concentrations in intravenous infusion systems: potassium chloride, insulin, and heparin.  

Science.gov (United States)

The investigation of concentrations of active agents in common carrier media for intravenous infusion revealed that potassium chloride tends to form a pool when it is added without mixing to carrier media in glass or polyvinyl chloride (PVC) containers which are already suspended in their functional position with ports pointing downwards. Heparin behaves in a similar fashion when added without mixing to carrier media in PVC containers. Such uneven distribution may expose a patient to potentially dangerous, possibly lethal, concentrations of a drug even when a relatively small amount of it is used. Insulin floats to the top of a Haemaccel container if its contents are not adequately mixed after addition of insulin. The resultant irregularity of insulin dosage may make the management of diabetic ketoacidosis more difficult. It is recommended that the instructions for the adequate mixing of contents should appear on all containers of carrier media for intravenous infusions. PMID:6755202

Bergman, N; Vellar, I D

1982-09-18

3

Pharmacokinetics of continuous subcutaneous insulin infusion  

DEFF Research Database (Denmark)

One of the reasons for the variability of blood glucose regulation in Type 1 (insulin-dependent) diabetic patients is the huge variation in subcutaneous absorption of intermediate-acting insulin. We have investigated the variation in insulin absorption during continuous subcutaneous insulin infusion in eight such patients. The content of insulin in the subcutaneous tissue was measured using 125I-labelled insulin. The concentration of free serum insulin and blood glucose was followed from 1 h before and from 7 h after breakfast on two consecutive days. The amount of insulin absorbed during 24 h differed in all cases by less than 3% from the daily insulin dose given by the pumps. Mean insulin absorption rates and mean free insulin concentration showed peak values 30-90 min after meal bolus injections; this was sufficient to maintain near-normal blood glucose. Mean free serum insulin correlated strongly with disappearance of insulin from the subcutaneous tissue (r = 0.98). From the insulin absorption rates and free insulin concentrations during basal constant insulin infusion, the half-time of serum insulin was calculated as 6 min. Compared with the known large variability in the absorption of intermediate-acting insulin, continuous subcutaneous insulin infusion offers a precise and reproducible way of insulin administration resulting in post-prandial serum insulin peaks sufficient to maintain near-normal blood glucose levels. The half-time of serum insulin during subcutaneous infusion corresponds to values for intravenous infusion given in the literature, indicating that local degradation of insulin in subcutaneous tissue is of minor importance.

Lauritzen, Torsten; Pramming, S

1983-01-01

4

Changes in Basal Insulin Infusion Rates With Subcutaneous Insulin Infusion  

Science.gov (United States)

OBJECTIVE Evaluation of the time required until a change in the basal insulin infusion rate with an insulin pump induces subsequent changes in the metabolic effect. RESEARCH DESIGN AND METHODS In this euglycemic glucose clamp study, 10 male subjects with type 1 diabetes received three different subcutaneous insulin infusion rates (0.5, 1.0, and 2.0 units/h; for 4 h each) of insulin lispro (IL) with insulin pumps. RESULTS An increase in insulinemia occurred within 15–30 min after changing the infusion rate. While the serum IL levels reached a steady state at the end of the infusion period, the glucose infusion rates did not always reach steady-state levels with the higher infusion rates. However, an increase in the glucose consumption occurred within 30–60 min after switching the infusion rate. CONCLUSIONS Several hours are required until a new steady state in the metabolic effect is achieved after a significant change in basal insulin infusion. PMID:19487635

Heinemann, Lutz; Nosek, Leszek; Kapitza, Christoph; Schweitzer, Matthias-Axel; Krinelke, Lars

2009-01-01

5

Hypovolaemia after glucose-insulin infusions in volunteers  

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Abstract High-dose intravenous infusion of glucose 5% promotes rebound hypoglycaemia and hypovolaemia in healthy volunteers. To study whether such effects occur in response to glucose-insulin, 12 healthy firemen (mean age 39 years) received 3 infusions over 1-2 hours that contained 20 ml/kg of glucose 2.5%, 5 ml/kg of glucose 10% with rapid-acting insulin 0.05 U/kg, and 4 ml/kg of glucose 50% with 1 U/kg of insulin. The plasma glucose concentration and plasma dilution were compared...

2008-01-01

6

Insulin Infusion Set: The Achilles Heel of Continuous Subcutaneous Insulin Infusion  

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Continuous subcutaneous insulin infusion from an insulin pump depends on reliable transfer of the pumped insulin to the subcutaneous insulin depot by means of an insulin infusion set (IIS). Despite their widespread use, the published knowledge about IISs and related issues regarding the impact of placement and wear time on insulin absorption/insulin action is relatively small. We also have to acknowledge that our knowledge is limited with regard to how often patients encounter issues with IIS...

Heinemann, Lutz; Krinelke, Lars

2012-01-01

7

Intravenous infusions in chronic pain management.  

Science.gov (United States)

In the United States, millions of Americans are affected by chronic pain, which adds heavily to national rates of morbidity, mortality, and disability, with an ever-increasing prevalence. According to a 2011 report titled Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research by the Institute of Medicine of the National Academies, pain not only exacts its toll on people's lives but also on the economy with an estimated annual economic cost of at least $560 - 635 billion in health care costs and the cost of lost productivity attributed to chronic pain. Intravenous infusions of certain pharmacologic agents have been known to provide substantial pain relief in patients with various chronic painful conditions. Some of these infusions are better, and although not necessarily the first therapeutic choice, have been widely used and extensively studied. The others show promise, however are in need of further investigations. This article will focus on non-opiate intravenous infusions that have been utilized for chronic painful disorders such as fibromyalgia, neuropathic pain, phantom limb pain, post-herpetic neuralgia, complex regional pain syndromes (CRPS), diabetic neuropathy, and central pain related to stroke or spinal cord injuries. The management of patients with chronic pain conditions is challenging and continues to evolve as new treatment modalities are explored and tested. The following intravenous infusions used to treat the aforementioned chronic pain conditions will be reviewed: lidocaine, ketamine, phentolamine, dexmedetomidine, and bisphosphonates. This overview is intended to familiarize the practitioner with the variety of infusions for patients with chronic pain. It will not, however, be able to provide guidelines for their use due to the lack of sufficient evidence. PMID:23703410

Kosharskyy, Boleslav; Almonte, Wilson; Shaparin, Naum; Pappagallo, Marco; Smith, Howard

2013-01-01

8

INTRAVENOUS FENTANYL INFUSION AS AN ANALAGESIC AGENTS FOR LABOR PAIN  

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Introduction. There are few studies about intravenous fentanyl infusion for reduce labor pain. This study evaluate the usefulness of intravenous fentanyl infusion for labor analgesia. Methods. Seventy seven healthy pregnant women were randomized to recive 1.5-2.5µg/kg/hr intravenous fentanyl infusion (interventional group) or placebo (control group). Maternal labor pain intensity, systolic, diastolic and mean arterial blood pressure, pulse and respiratory rate, frequency of nausea and v...

Soltani Nezhad, H.; SH ARAM; Monajjemi, Z.; Jaafar-zadeh, L.

2001-01-01

9

Subcutaneous insulin infusion: change in basal infusion rate has no immediate effect on insulin absorption rate  

International Nuclear Information System (INIS)

Eight insulin-dependent diabetic patients were simultaneously given subcutaneous infusions (1.12 IU/h each) of 125I-labeled Actrapid insulin in each side of the abdominal wall. After 24 h of infusion, the size of the infused insulin depots was measured by external counting for 5 h. The basal infusion rate was then doubled in one side and halved in the other for the next 4 h. Finally, 1.12 IU/h of insulin was given in both sides of the abdominal wall for an additional 3 h. The changes in the size of the depots were measured, and the absorption rates for each hour were calculated. During the first 5 h of infusion, the depot size was almost constant (approximately 5 IU) with an absorption rate that equaled the infusion rate. Doubling the infusion rate led to a significant increase in depot size, but the absorption rate remained unchanged for the first 3 h, and only thereafter was a significant increase seen. When the infusion rate was reduced to the initial 1.12 IU/h, the absorption rate remained elevated during the next 3 h. Correspondingly, when the infusion rate was decreased, the depot size also decreased, but the absorption rate remained unchanged for the first 3 h. The results show that a change in the basal insulin infusion rate does not lead to any immediate change in the insulin absorption rate. This should be considered when planning an insulin-infusion program that includes alteration(s) in the basal-rate settingtting

10

Thrombolytic treatment for acute ischemic cerebral stroke: intraarterial urokinase infusion vs. intravenous heparin and urokinase infusion  

International Nuclear Information System (INIS)

To evaluate the efficacy and limitation of intra-arterial urokinase (IAUK) infusion for treatment of acute cerebral stroke. Twenty-seven acute cerebral stroke patients treated with IAUK infusion within six hours of stroke onset were reviewed. All patients showed normal initial brain findings on CT. In 21 patients, urokinase(5-15 x 105IU) was administered through a microcatheter placed into or proximal to occluded segment. Mechanical disruption of thrombus by guidewire was performed in 17 patients. Angiographic and clinical responses and complications after IAUK infusion, were evaluated and the results were compared with those of intravenous heparin(N=19) and urokinase infusion(N=19). Complete or partial angiographic recanalization of occluded segment was found in 18 patients (67%), and neurologic improvement was followed in 14 patients(52%). The degree of improvement on the stroke scale score after IAUK infusion was statistically more significant(p<0.05) than that shown after intravenous heparin and urokinase infusion. Complications after IAUK infusion were large(15%) and small amount intracerebral hemorrhage(15%), contrast leakage into brain parenchyma(11%), and gastrointestinal bleeding(4%). Between the IAVK and the intravenous urokinase infusion group, differences in extent and types of complications were statistically insignificant, but were significantly higher in those two groups than in the intravenous heparin infusion group. IAUK infusion may be effn infusion group. IAUK infusion may be effective for the treatment of acute cerebral stroke

11

Splanchnic and renal exchange of infused fructose in insulin-deficient type 1 diabetic patients and healthy controls.  

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Fructose raises blood glucose and lactate levels in normal as well as diabetic man, but the tissue origin (liver and/or kidney) of these responses and the role of insulin in determining the end products of fructose metabolism have not been fully established. Splanchnic and renal substrate exchange was therefore examined during intravenous infusion of fructose or saline in six insulin-deficient type I diabetics who fasted overnight and in five healthy controls. Fructose infusion resulted in si...

Bjo?rkman, O.; Gunnarsson, R.; Hagstro?m, E.; Felig, P.; Wahren, J.

1989-01-01

12

A new miniature, open-loop, extracorporeal insulin infusion pump.  

Science.gov (United States)

This extracorporeal insulin infuser has been designed to be compact, simple to operate, and suitable either for clinical investigations of insulin-dependent diabetes mellitus or for long term treatment of the condition. A syringe driver of unconventional design is used, and the syringe will be available prefilled with insulin, specially formulated at standard strength for long term infusion. The device is electronically controlled to give variable rates of basal infusion, preset by switch and supplemented by bolus infusions demanded by pushbutton prior to meals. Sufficient insulin is carried in the syringe to meet the needs of most diabetics for at least a week without refilling, and the battery life is commensurately long. Signalling of the mealtime dose regime, and of alarm and failure conditions is by audible means. Insulin will most commonly be delivered subcutaneously, though other routes are possible. PMID:6887820

Rothwell, D; Sutherland, I A; Pickup, J C; Bending, J J; Keen, H; Parsons, J A

1983-07-01

13

Continuous intravenous infusions of bromodeoxyuridine as a clinical radiosensitizer  

International Nuclear Information System (INIS)

Twelve patients were treated with continuous intravenous (24-hour) infusions of bromodeoxyuridine (BUdR) at 650 or 1000 mg/m2/d for up to two weeks. Myelosuppression, especially thrombocytopenia, was the major systemic toxicity and limited the infusion period to nine to 14 days. However, bone marrow recovery occurred within seven to ten days, allowing for a second infusion in most patients. Local toxicity (within the radiation field) was minimal, with the exception of one of four patients, who underwent abdominal irradiation. Pharmacology studies revealed a steady-state arterial plasma level of 6 x 10(-7) mol/L and 1 x 10(-6) mol/L during infusion of 650 and 1000 mg/m2/d, respectively. In vivo BUdR uptake into normal bone marrow was evaluated in two patients by comparison of preinfusion and postinfusion in vitro radiation survival curves of marrow CFUc with enhancement ratios (D0-pre/D0-post) of 1.8 (with 650 mg/m2/d) and 2.5 (with 1000 mg/m2/d). In vivo BUdR incorporation into normal skin and tumor cells using an anti-BUdR monoclonal antibody and immunohistochemistry was demonstrated in biopsies from three patients revealing substantially less cellular incorporation into normal skin (less than 10%) compared with tumor (up to 50% to 70%). The authors conclude that local and systemic toxicity of continuous infusion of BUdR at 1000 mg/m2/d for approximately two weeks is tolerable. The observed normal tissue toxicity is comparable with previous clinical experience with intermittent (12 hours every day for two weeks) infusions of BUdR. Theoretically, a constant infusion should allow for greater incorporation of BUdR into cycling tumor cells and thus, for further enhancement of radiosensitization

14

Glucose uptake and pulsatile insulin infusion: euglycaemic clamp and [3-3H]glucose studies in healthy subjects  

International Nuclear Information System (INIS)

To test the hypothesis that insulin has a greater effect on glucose metabolism when given as pulsatile than as continuous infusion, a 354-min euglycaemic clamp study was carried out in 8 healthy subjects. At random order soluble insulin was given intravenously either at a constant rate of 0.45mU/kg · min or in identical amounts in pulses of 11/2 to 21/4 min followed by intervals of 101/2 to 93/4 min. Average serum insulin levels were similar during the two infusion protocols, but pulsatile administration induced oscillations ranging between 15 and 62 ?U/ml. Glucose uptake expressed as metabolic clearance rate (MCR) for glucose was significantly increased during pulsatile insulin delivery as compared with continuous administration (270-294 min: 8.7±0.7 vs 6.8±0.9 ml/kg · min, P 3H]glucose infusion technique was suppressed to insignificant values. Finally, the effect of insulin on endogenous insulin secretion and lipolysis as assessed by changes in serum C-peptide and serum FFA was uninfluenced by the infusion mode. In conclusion, insulin infusion resulting in physiological serum insulin levels enhances glucose uptake in peripheral tissues in healthy subjects to a higher degree when given in a pulsed pattern mimicking that of the normal endocrine pancreas than when given as a continuous infusion. (author)

15

[Treatment of resistance to subcutaneous insulin with implanted insulin infusion pumps].  

Science.gov (United States)

Four female patients, resistant to insulin administered subcutaneously, were treated with an implanted insulin infusion pump (Infusaid; constant rate infusion). They had all experienced as many as four episodes of ketoacidosis per month despite extremely high doses of insulin injected subcutaneously or intramuscularly, and none of the treatment approaches attempted--insulin delivery via subclavian catheter, Schade-port, insulin infusion with an external portable pump or various insulin additives--had been successful. After implantation of the pump the daily insulin dose, which had been between 300 and 3000 units during subcutaneous therapy, was reduced to 30 to 70 units per day. The patients' condition improved, no further episodes of ketoacidosis occurred and hospital stays were reduced significantly. In the further course of treatment pump and catheter-related complications had to be overcome. PMID:3138098

Löchli, S; Campbell, I; Dorenboos, H; Paterson, K R; Devlin, J G; Hagmüller, G; Irsigler, K

1988-09-01

16

Cardiovascular effects of intravenous ghrelin infusion in healthy young men  

DEFF Research Database (Denmark)

Ghrelin infusion improves cardiac function in patients suffering from cardiac failure, and bolus administration of ghrelin increases cardiac output in healthy subjects. The cardiovascular effects of more continuous intravenous ghrelin exposure remain to be studied. We therefore studied the cardiovascular effects of a constant infusion of human ghrelin at a rate of 5 pmol/kg per minute for 180 min. Fifteen healthy, young (aged 23.2 +/- 0.5 yr), normal-weight (23.0 +/- 0.4 kg/m(2)) men volunteered in a randomized double-blind, placebo-controlled crossover study. With the subjects remaining fasting, peak myocardial systolic velocity S', tissue tracking TT, left ventricular ejection fraction EF, and endothelium-dependent flow-mediated vasodilatation were measured. Ghrelin infusion increased S' 9% (P = 0.002) and TT 10% (P <0.001), whereas EF, resting blood flow velocity, and endothelium-dependent flow-mediated vasodilatation did not change (P = 0.13). This was associated with a peak in serum growth hormone after 60 min of infusion (37.77 +/- 5.27 ng/ml, P <0.001), a doubling of free fatty acid levels (P = 0.001), and a 1.6-fold increase in cortisol levels (P <0.05), whereas glucose and catecholamine levels were constant. In conclusion, supraphysiological levels of ghrelin stimulate left ventricular function in terms of S' and TT in healthy young normal-weight men without changing resting blood flow velocity and endothelium-dependent flow-mediated vasodilatation. The effects did not translate into detectable increments in EF.

Vestergaard, Esben Thyssen; Andersen, Niels Holmark

2007-01-01

17

Inhibitory effect of intravenous lysine infusion on urea cycle metabolism.  

Science.gov (United States)

Intravenous infusion of 0.5 mmol/kg L-lysine monohydrochloride was performed in six normal volunteer subjects aged 10-14 years to study the inhibitory effect of lysine on urea cycle metabolism. The lysine infusion resulted in a significant increase in plasma levels of arginine and ornithine, and in urinary homocitrulline, putrescine, and orotic acid, accompanied by a significant increase in blood ammonia. There was little change in plasma urea and citrulline. The increase in plasma arginine appears to reflect an inhibited arginase activity although the plasma urea level did not change. The increased homocitrulline excretion suggests that ornithine conversion to citrulline via ornithine transcarbamylase (OTC) was inhibited. The simultaneous increase in plasma ornithine and urinary putrescine may reflect an inhibition of mitochondrial ornithine transport. In addition to the direct ammoniagenic property of lysine, impaired ornithine conversion to citrulline resulting from the inhibition of both OTC activity and mitochondrial ornithine uptake by lysine may be responsible for the increase in blood ammonia and urinary orotic acid. Despite the retarded citrulline formation, a promoted efflux of citrulline from mitochondria may have kept the plasma citrulline level unchanged. PMID:3107993

Kato, T; Sano, M; Mizutani, N

1987-01-01

18

Continuous subcutaneous insulin infusion in type 1 diabetic Saudi children. A comparison with conventional insulin therapy.  

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Continuous subcutaneous insulin infusion improved the glycemic control in diabetic Saudi children with decreased frequency of hypoglycemic episodes and DKA events. Long follow-up studies are needed to confirm these results.

Bassam S. Bin-Abbas

2005-06-01

19

Metabolic response of normal man and insulin-infused diabetics to postprandial exercise.  

Science.gov (United States)

Physical exercise is often performed during absorption of meals. We have characterized the metabolic response to 45 min of moderate exercise (approximately 55% of estimated maximal oxygen uptake) beginning 30 min after breakfast in seven healthy controls. Nine insulin-dependent diabetes were studied in an identical manner, with glycemia controlled by a closed-loop "artificial endocrine pancreas" controlled by a closed-loop "artificial endocrine pancreas" (AEP). Responses were compared to those during breakfast without exercise. In the controls, onset of exercise rapidly reversed the rise in both glycemia and insulin (IRI) that occurred with breakfast alone, both returning to fasting levels (glycemia, 80 +/- 3 mg/dl; IRI, 0.38 +/- 0.10 ng/ml). After exercise, small and transient increments occurred (glycemia, 33 +/- 6 mg/dl; IRI, 0.81 +/- 0.15 ng/ml). In the diabetics, prior overnight intravenous insulin normalized fasting glycemia (98 +/- 4 mg/dl), and its postbreakfast excursion was identical to that of controls, as were those of most measured substrates. Similarly, with exercise, glycemia returned rapidly to fasting levels, accompanied by an appropriate decrease in insulin infusion rates. "Free" IRI levels mirrored changes in infusion rates by the AEP, with a decrease in insulin requirement of 30% during exercise as compared to breakfast alone (P less than 0.05). Thus, in both diabetics treated with the AEP and in normals, the responses to postprandial exercise required rapid modulation of insulin delivery. To demonstrate the effect of postprandial exercise on preprogrammed open-loop insulin replacement, four diabetic subjects were studied during breakfast with and without exercise while receiving a fixed open-loop insulin infusion pattern (6.1 +/- 0.7 U over 140 +/- 8 min). The glycemic response to breakfast alone was entirely normalized. However, symptomatic hypoglycemia occurred in all subjects when exercise was initiated 30 min after breakfast. The diabetic responses to closed-loop insulin infusion provide important data in defining the appropriate preprogrammed open-loop insulin infusion pattern for postprandial exercise. PMID:7044140

Nelson, J D; Poussier, P; Marliss, E B; Albisser, A M; Zinman, B

1982-05-01

20

Haemolytic anaemia as a complication to intravenous immunoglobulin infusion  

DEFF Research Database (Denmark)

Intravenous immunoglobulin (IVIg) is an established treatment for various neuromuscular disorders. Recently, we have observed a few cases of haemolytic anaemia following IVIg treatment. The objective of this study was to determine the extent of anaemia and haemolysis as a complication to IVIg. In a prospective study we included 28 post-polio patients treated with 2g per kilo of Privigen® and 22 CIDP patients treated with 1.7±0.4 (mean±SD) g per kilo of Kiovig®. The post-polio patients were all IVIg treatment naitive whereas the CIDP patients were in maintenance therapy. Venous blood samples were performed before and two weeks after infusion of IVIg. Following treatment blood haemoglobin declined from 8.6±0.8 to 8.1±1.3mmol/l, p<0.001. Furthermore, decreasing haptoglobin and increasing reticulocyte count, blood bilirubin, and lactate dehydrogenase were observed, all p<0.05. The decrease of haemoglobin was 0.79±1.2 in the treatment naive versus 0.25±0.3mmol/l in the long-term treated patients, p=0.05. Alterations of reticulocyte count, haptoglobin and lactate dehydrogenase were more pronounced in the treatment naive group, all p<0.05. In 7 patients we observed a substantial decline of haemoglobin of more than 1.5mmol/l (1.8-2.9). Six of those 7 patients had undetectable levels of haptoglobin after IVIg and the mean reticulocyte count, blood bilirubin and lactate dehydrogenase increased 420%, 130% and 108%. All were in the de-novo treated group. Our observations indicate that treatment naive patients are susceptible to develop haemolysis. Haemolytic anaemia is a severe side effect that seems to be more frequent after immunoglobulin infusions than previously recognized.

Markvardsen, Lars HØj; Harbo, Thomas

 
 
 
 
21

Insulin Infusion in Conscious Dogs: EFFECTS ON SYSTEMIC AND CORONARY HEMODYNAMICS, REGIONAL BLOOD FLOWS, AND PLASMA CATECHOLAMINES  

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Cardiovascular actions of insulin were studied by intravenous infusions of insulin (4 and 8 mU/kg per min) in normal conscious dogs. This resulted in increases in cardiac output, heart rate, and left ventricular derivative of pressure with respect to time (dP/dt) and dP/dt/P, as blood glucose was reduced. The inotropic and chronotropic effects of insulin were not related to hypoglycemia, as they persisted even when blood glucose was restored to control values or when it was prevented from fal...

Liang, Chang-seng; Doherty, John U.; Faillace, Robert; Maekawa, Kishio; Arnold, Stephanie; Gavras, Haralambos; Hood, William B.

1982-01-01

22

Effect of Insulin Infusion on Liver Protein Synthesis during Hemodialysis  

DEFF Research Database (Denmark)

Background Hemodialysis (HD) is a catabolic procedure that may contribute to the high frequency of protein-energy wasting among patients receiving maintenance HD. The present study investigated the additional effect of glucose and glucose-insulin infusion on liver protein synthesis during HD compared with a meal alone. Methods In a randomized cross-over study with three arms, 11 non-diabetic HD patients were assigned to receive a conventional HD session with either: • no treatment (NT) • IV infusion of glucose (G) • IV infusion of glucose-insulin (GI) During infusions blood glucose levels were maintained at 8.0-10.0 mmol/L by additional glucose infusion. Glucose and glucose-insulin infusions were commenced 2 h prior to HD and continued throughout the HD session. Fasting blood samples were collected at baseline before infusion and followed by the only meal allowed during the study. Results Blood glucose and insulin: The change in blood glucose differed significantly from baseline (-120 min) to end of HD (240 min) between the NT group and the G group (p=0.002); there was no significant difference in the change between the NT group and the GI group (p=0.06), or between the G group and the GI group (p=0.15). Fibrinogen and albumin: There was an overall increase in serum albumin (38.8±2.1 to 40.4±2.5 g/L, p<0.0001) and in serum fibrinogen (11.7±1.7 to 12.8±1.8 µmol/L, p<0.0001) from HD start (0 min) to 2 h post HD (360 min), but no significant difference in the change in either albumin (p=0.12) or fibrinogen (p=0.12) between the groups. IGFBP-1: During the first 4 h after baseline (-120 min) we observed an overall decrease in serum IGF-binding protein 1 (IGFBP-1) (from 267±147 to 140±84 µg/L, p<0.0001), but no difference in the change between groups (p=0.41). However, from 4 h after baseline to the end of the study there was a significant difference in the change in serum IGFBP-1 between the groups (p=0.003) with a significant increase in serum IGFBP-1 in the NT group (p<0.0001), but not in the G group or GI group (p=0.50 and p=0.07, respectively). Conclusions Compared with a meal neither glucose nor glucose-insulin infusion appear to have any extra effects on liver protein synthesis during HD.

Reinhard, Mark; Frystyk, Jan

23

A Review of the Security of Insulin Pump Infusion Systems  

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Insulin therapy has enabled diabetic patients to maintain blood glucose control to lead healthier lives. Today, rather than manually injecting insulin using syringes, a patient can use a device, such as an insulin pump, to programmatically deliver insulin. This allows for more granular insulin delivery while attaining blood glucose control. The insulin pump system features have increasingly benefited patients, but the complexity of the resulting system has grown in parallel. As a result security breaches that can negatively affect patient health are now possible. Rather than focus on the security of a single device, we concentrate on protecting the security of the entire system. In this paper we describe the security issues as they pertain to an insulin pump system that includes an embedded system of components including the insulin pump, continuous glucose management system, blood glucose monitor, and other associated devices (e.g., a mobile phone or personal computer). We detail not only the growing wireless communication threat in each system component, but we also describe additional threats to the system (e.g., availability and integrity). Our goal is to help create a trustworthy infusion pump system that will ultimately strengthen pump safety, and we describe mitigating solutions to address identified security issues both for now and in the future.

Klonoff, David C. [Mills-Peninsula Health Services; Paul, Nathanael R [ORNL; Kohno, Tadayoshi [University of Washington, Seattle

2011-01-01

24

Analysis of the Environmental Impact of Insulin Infusion Sets Based on Loss of Resources with Waste  

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Insulin pump therapy [continuous subcutaneous insulin infusion (CSII)] requires regular change of infusion sets every 2-3 days in order to minimize the risk of skin irritations or other adverse events. This has been discussed to be a potential burden to the environment. The purpose of this analysis was to perform an environmental assessment of insulin pump infusion sets based on loss of resources occurring during incineration of the discarded products and by means of a lifecycle concept used ...

Pfu?tzner, Andreas; Musholt, Petra B.; Malmgren-hansen, Bjoern; Nilsson, Nils H.; Forst, Thomas

2011-01-01

25

Changes in basal insulin infusion rates with subcutaneous insulin infusion: time until a change in metabolic effect is induced in patients with type 1 diabetes.  

Science.gov (United States)

OBJECTIVE Evaluation of the time required until a change in the basal insulin infusion rate with an insulin pump induces subsequent changes in the metabolic effect. RESEARCH DESIGN AND METHODS In this euglycemic glucose clamp study, 10 male subjects with type 1 diabetes received three different subcutaneous insulin infusion rates (0.5, 1.0, and 2.0 units/h; for 4 h each) of insulin lispro (IL) with insulin pumps. RESULTS An increase in insulinemia occurred within 15-30 min after changing the infusion rate. While the serum IL levels reached a steady state at the end of the infusion period, the glucose infusion rates did not always reach steady-state levels with the higher infusion rates. However, an increase in the glucose consumption occurred within 30-60 min after switching the infusion rate. CONCLUSIONS Several hours are required until a new steady state in the metabolic effect is achieved after a significant change in basal insulin infusion. PMID:19487635

Heinemann, Lutz; Nosek, Leszek; Kapitza, Christoph; Schweitzer, Matthias-Axel; Krinelke, Lars

2009-08-01

26

Reassessment of insulin dosing guidelines in continuous subcutaneous insulin infusion treated type 1 diabetes.  

Science.gov (United States)

It is a daunting task to initiate or evaluate continuous subcutaneous insulin infusion, pump, dosing in a patient with type 1 diabetes. Choosing a low dose may lead to hyperglycemia or, too high, hypoglycemia. Mathematical dosing guidelines were used with the first human insulin injection in 1922. Since that time, they have been enlarged and modified. The current widely published guidelines were developed from retrospective evaluations of pump-downloads in patients without specified diet conditions or timed glucose testing. When diet is controlled and glucose testing is timed to evaluate post-meal excursions and during sleep, recent prospective studies found that these current dosing recommendations for basal insulin were too high and for bolus insulin too low. Further, simple mathematical interrelationships were published that kept the right proportions between the bolus dosing factors and the basal dose. PMID:24792068

King, Allen Bennett

2014-06-01

27

The role of 5-hydroxytryptamine in the feline response to intravenous infusion of live E. coli.  

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A standardized septic shock was induced in cats by intravenous infusion of a live E. coli bacteria strain. The bacterial infusion induced a rapid haemodynamic response characterized mainly by a pulmonary arterial hypertension and a late phase characterized by systemic hypotension and hypodynamic circulation. Systemic arterial, pulmonary arterial, portal venous, left atrial pressures, max inspiratory-expiratory pressure difference in the trachea, aortic and intestinal blood flows were monitore...

Arvidsson, S.; Falk, A.; Haglind, E.; Haglund, U.

1983-01-01

28

Effects of Intrarenal and Intravenous Infusion of the Phosphodiesterase 3 Inhibitor Milrinone on Renin Secretion  

Science.gov (United States)

We have reported that administration of the phosphodiesterase III inhibitor milrinone increases renin secretion in conscious rabbits. The aim of the present study was to determine if the increase in renin secretion results from a direct renal action of milrinone, or from an indirect extrarenal effect of the drug. This was accomplished by comparing the effects of intrarenal and intravenous infusion of graded doses of milrinone on plasma renin activity in unilaterally nephrectomized conscious rabbits. Milrinone was infused into the renal artery in doses of 0.01, 0.1 and 1.0 micro-g/kg/min, and intravenously in the same rabbits in doses of 0.01, 0.1, 1.0 and 10 micro-g/kg/min. Each dose was infused for 15 min. No intrarenal dose of milrinone altered plasma renin activity or arterial pressure, although at the highest dose, there was a small increase in heart rate. Intravenous infusion of milrinone at 1.0 micro-g/kg/min increased plasma renin activity to 176 +/- 55% of the control value (P less than 0.05). Heart rate increased but arterial pressure did not change. Intravenous infusion of milrinone at 1O micro-g/kg/min increased plasma renin activity to 386 +/- 193% of control in association with a decrease in arterial pressure and an increase in heart rate. These results confirm that milrinone increases renin secretion, and indicate that the stimulation is due to an extrarenal effect of the drug.

Kumagai, Kazuhiro; Reid, Ian A.

1994-01-01

29

Treatment of lung cancer with bronchial artery infusion of cisplatin and intravenous sodium thiosulfate rescue  

International Nuclear Information System (INIS)

Forty-nine patients with primary lung cancer were treated with bronchial artery infusion of cisplatin and intravenous injection of an antidote, sodium thiosulfate. More than 50% reduction of tumor size (PR) was observed in 8 of 9 small cell carcinomas (SCLC) and in 16 of 40 non-small cell carcinomas (NSCLC). In NSCLC patients PR was obtained in 71% (12/17) after repeated infusions (? 200 mg cisplatin) and in 17% (4/23) after a single infusion (? 150 mg cisplatin). There was a significant linear relationship between cisplatin dose and tumor reduction in this group. No severe adverse effects were encountered. (orig.)

30

Boron biodistribution in Beagles after intravenous infusion of 4-dihydroxyborylphenylalanine-fructose complex  

Energy Technology Data Exchange (ETDEWEB)

Boron biodistribution after intravenous infusion of 4-dihydroxyborylphenylalanine-fructose (BPA-F) complex was investigated in six dogs. Blood samples were evaluated during and following doses of 205 and 250 mg/kgbw BPA in a 30 min infusion, and 500 mg/kgbw in a 1 h infusion. Samples from whole blood, urine, brain and other organs were analysed for boron content after varying times following the onset of infusion. The whole blood boron concentrations declined from 27 to 8.4 ppm over the period of 39-165 min after the onset of infusion and the levels increased from 1.9 to 12 ppm in the grey matter of the brain over the same period. The boron concentrations in whole blood decreased steadily, whereas the boron values in brain tissue rose steadily with time. It was concluded that whole blood boron concentrations do not seem to reflect accurately the boron concentration in brain tissue at respective time points.

Kulvik, M.E. E-mail: martti.kulvik@welho.com; Vaehaetalo, J.K.; Benczik, J.; Snellman, M.; Laakso, J.; Hermans, R.; Jaerviluoma, E.; Rasilainen, M.; Faerkkilae, M.; Kallio, M.E

2004-11-01

31

Continuous subcutaneous insulin infusion with short-acting insulin analogues or human regular insulin: efficacy, safety, quality of life, and cost-effectiveness.  

Science.gov (United States)

Portable insulin infusion devices are effective and safe insulin delivery systems for managing diabetes mellitus, especially type 1 diabetes. Rapidly absorbed insulin analogues, such as insulin lispro or insulin aspart, may offer an advantage over regular human insulin for insulin pumps. Several open-label randomised crossover trials demonstrated that continuous subcutaneous insulin infusion (CSII) with insulin lispro provided a better control of postprandial hyperglycaemia and a slightly but significantly lower glycated haemoglobin level, with lower daily insulin requirement and similar or even less hypoglycaemic episodes. A CSII study comparing insulin lispro and insulin aspart demonstrated similar results with the two analogues, and better results than those with regular insulin. Because these analogues have a quicker onset and a shorter duration of action than regular insulin, one might expect an earlier and greater metabolic deterioration in case of CSII interruption, but a more rapid correction of metabolic abnormalities after insulin boluses when reactivating the pump. These expectations were confirmed in randomised protocols comparing the metabolic changes occurring during and after CSII interruption of various durations when the pump infused either insulin lispro or regular insulin. The extra cost resulting from the use of CSII and insulin analogues in diabetes management should be compensated for by better metabolic control and quality of life. In conclusion, CSII delivering fast-acting insulin analogues may be considered as one of the best methods to replace insulin in a physiological manner by mimicking meal and basal insulin requirements, without higher risk of hypoglycaemia or ketoacidosis in well-educated diabetic patients. PMID:15133748

Radermecker, Régis Pierre; Scheen, André Jacques

2004-01-01

32

Multiorgan crystal deposition following intravenous oxalate infusion in rat  

International Nuclear Information System (INIS)

Deposition of calcium oxalate is responsible for the pathologic manifestations of oxalosis and may contribute to multiorgan dysfunction in uremia and to the progression of renal damage after renal failure is established. We have developed a rat model of oxalosis using a single intravenous injection of sodium oxalate, 0.3 mmol./kg. body weight, in rats. Polarized light microscopy and section freeze-dry autoradiography were used to identify 14C-oxalate within the renal parenchyma and in extrarenal organs. 14C-oxalate crystals under three mu in length were identified within one min. of injection in proximal tubule lumens. Section freeze-dry autoradiography showed occasional minute crystals within glomeruli, heart, lung and liver at one hr. In contrast to concentrative cellular uptake demonstrated in rat renal cortical slices in vitro, intracellular accumulation of 14C-oxalate could not be detected in vivo. Within the first 24 hr., renal oxalate retention reached a maximum of 25 +/- 4 per cent of the injected dose/gm. kidney compared to a maximum of only 7 +/- 3 per cent/gm. kidney after intraperitoneal administration. Although less than one per cent dose/gm. kidney remained after one week, crystal fragments were scattered throughout the cortex and medulla, often surrounded by foci of interstitial nephritis. The retention of crystals in kidney and other body organs following i.v. oxalate provides a model of oxalosis which stimulates pathophysiologic events in a variety of clinical situations characterized by transiently or persistently elevated serum oxalate

33

Comparative study of intravenous urographic bolus (I.U.B.) and intravenous urographic infusion (I.U.I.) in dogs  

International Nuclear Information System (INIS)

Two urographic methods were compared: the intravenous urographic bolus (i.u.b.) and the intravenous urographic infusion (i.u.i.). In both methods, two groups of seven healthy adult dogs of both sexes, weighing7.0 to 16.5 kg were used and were anaesthesized with 2% thiopentone sodium in doses of 20 mg/kg via cephalica. In the i.u.b., meglumine diatrizoate (Hypaque-M, 60%) was injected via saphena with a concentration of 282 mg of iodine per mi in doses of 564 mg of iodine per kg. In the i.u.i., meglumine diatrizoate was injected via saphena by drip infusion with a concentration of 200 mg of iodine per mi in doses of 500 mg of iodine per kg. Three series of two X-rays each were taken in ventrodorsal projection 1, 4 and 8 min and left lateral recumbency 30 sec after administering the contrast medium. The X-ray plates obtained were analyzed and compared intra and inter group considering the advance speed of the contrast medium, the radiographic density and outline, and kidney size. The advance speed of the contrast medium was higher in the i.u.i., reaching the kidney, ureter and bladder 1 min after administration in both projections; in ventrodorsal projections in the i.u.b. only the kidneys were reached while in the left lateral recumbency, the kidney and ureters were reached

34

Uptake of iodinated deoxyuridine in a murine melonama following multiple-day intravenous infusions  

International Nuclear Information System (INIS)

Techniques are described for multi-day intravenous (i.v.) infusions of iodinated deoxyuridine (IdUrd) into mice. Percent incorporation into DNA as a thymidine (Thd) analog is reported, as measured by radioactive tag (125IdUrd) and by neutron activation analysis (NAA). Quantitative measurements of IdUrd incorporation in DNA are requisite for meaningful evaluation of the effects of radiation enhancement resulting from radiation sensitization and the stimulation of Auger cascades (photon activation)

35

The comparison of the effects of intravenous ketamine or dexmedetomidine infusion on spinal block with bupivacaine  

Science.gov (United States)

Background Ketamine and dexmedetomidine are commonly used for sedation and analgesia in patients. We tried to compare the effects of intravenous ketamine and dexmedetomidine infusion on spinal block with bupivacaine. Methods Ninety American Society of Anesthesiologists physical status class I or II patients, who were scheduled to spinal anesthesia were randomly assigned to one of three groups (n = 30). Normal saline 10 ml, 5 ml/hr (loading dose for 10 minutes, infusion) (Group NS), dexmedetomidine 1 µg/kg, 0.5 µg/kg/hr (Group DEX), or ketamine 0.2 mg/kg, 0.5 mg/kg/hr (Group KET) was infused intravenously before spinal anesthesia. We recorded the time to highest sensory block level, sensory and motor regression, and hemodynamic changes. Results Patients in Groups KET had a significantly faster onset time of sensory block than patients in Group NS. The highest sensory block levels were not significantly different between groups. Average time of sensory regression and knee flexion, was significantly longer in the Group KET and Group DEX than the Group NS. Conclusions Intravenous dexmedetomidine and ketamine were found to have a similar synergistic effect with intrathecal bupivacaine. Hemodynamic stability showed better results in Group KET.

Jung, Soon Yong; Shin, Jung Dea; Lee, Seoung Hun; Park, Min-Young; Lee, Kun Moo; Lee, Jeong Han; Cho, Kwangrae; Lee, Wonjin

2014-01-01

36

Effect of intravenous infusion of isotonic sodium bicarbonate solution on acidemic calves with diarrhea.  

Science.gov (United States)

The effect of 1.35% isotonic sodium bicarbonate solution (ISB) administered intravenously on acid-base equilibrium was examined in 18 acidemic Japanese black beef calves with spontaneous diarrhea. The infusion volumes of ISB were decided based on the first half volumes of base needed. In 72.2% (13/18) of calves, improvement of acidemia was detected. There was good correlation (r=0.693, p<0.01) between infused volume of ISB and changes in base excess (y=1.097x + 4.762). Infusion volumes of ISB were 7.5, 10.2, 12.9 and 15.7 ml/kg, respectively, enough to correcting the first half of 5, 10, 15 and 20 mEq/l of base deficit in acidemic calves. Our finding suggested that ISB could be used to correct metabolic acidosis without altering electrolyte concentrations in calves. PMID:12520117

Suzuki, Kazuyuki; Kato, Tosihide; Tsunoda, Gensei; Iwabuchi, Shigehiro; Asano, Kimi; Asano, Ryuji

2002-12-01

37

Treatment of lung cancer with bronchial artery infusion of cisplatin and intravenous sodium thiosulfate rescue  

Energy Technology Data Exchange (ETDEWEB)

Forty-nine patients with primary lung cancer were treated with bronchial artery infusion of cisplatin and intravenous injection of an antidote, sodium thiosulfate. More than 50% reduction of tumor size (PR) was observed in 8 of 9 small cell carcinomas (SCLC) and in 16 of 40 non-small cell carcinomas (NSCLC). In NSCLC patients PR was obtained in 71% (12/17) after repeated infusions (greater than or equal to 200 mg cisplatin) and in 17% (4/23) after a single infusion (less than or equal to 150 mg cisplatin). There was a significant linear relationship between cisplatin dose and tumor reduction in this group. No severe adverse effects were encountered.

Uchiyama, N.; Kobayashi, H.; Nakajo, M.; Shinohara, S.

1988-01-01

38

Differential effects of oral, peripheral intravenous, and intraportal glucose on hepatic glucose uptake and insulin and glucagon extraction in conscious dogs.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The effect of equal (1.1 +/- 0.1 g/kg body wt) amounts of glucose administered orally, or by peripheral intravenous or intraportal infusion on hepatic glucose uptake and fractional hepatic extraction of insulin and glucagon was studied in conscious dogs with chronically implanted Doppler flow probes on the portal vein and hepatic artery and catheters in the portal vein, hepatic vein, carotid artery, and superior mesenteric vein. Portal vein and hepatic vein plasma flow increased only after or...

Ishida, T.; Chap, Z.; Chou, J.; Lewis, R.; Hartley, C.; Entman, M.; Field, J. B.

1983-01-01

39

Plastic particle migration during intravenous infusion assisted by a peristaltic finger pump in an animal model.  

Science.gov (United States)

The contamination of intravenously administered fluid with foreign material has always been of major concern, but the in-vivo impact of silicone embolisation from administration of fluid via a peristaltic finger pump (PFP) has not previously been assessed. To determine whether silicone particles enter the lungs and to review the histological response, 10 rabbits received an IV infusion of 0.9% saline at 10 ml/kg per hour over a 72-h period, via an IVAC 591 PFP. The lungs were analysed for silicone particles with scanning electron microscopy (SEM) and energy-dispersive X-ray analysis (EDXA). These results were compared with a control group of non-infused animals. Silicone particles were found in 8 of 10 animals in the experimental group and in 2 of 9 control animals, indicating that silicone particles are dislodged during pump-assisted IV infusions. The difference between the control and infused animals was statistically significant using Fisher's exact test (P = 0.023). However, silicone plastic particles in control animals suggest that there is also environmental exposure to silicone in addition to those particles that come from a therapeutic source. The additional finding of elemental silicon (which is one of the constituents of silicone plastic) in both infused and control animals in which silicone plastic was not found indicates that not all elemental silicon in animals reflects the presence of silicone plastic. The clinical significance of each of these two findings is yet to be determined. PMID:12415345

Dewan, P A; Ehall, H; Edwards, G A; Middleton, D J; Terlet, J

2002-09-01

40

Unprecedented high insulin secretion in a healthy human subject after intravenous glucagon-like peptide-1 : a case report  

DEFF Research Database (Denmark)

BACKGROUND: The gut-derived incretin hormones, glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1, are released in response to ingestion of nutrients. Both hormones are highly insulinotropic in strictly glucose-dependent fashions and glucagon-like peptide-1 is often referred to as one of the most insulinotropic substances known. CASE PRESENTATION: Plasma insulin and C-peptide concentrations were measured in a healthy Caucasian male (age: 53 years; body mass index: 28.6 kg/m2; fasting plasma glucose: 5.7 mM; 2 h plasma glucose value following 75 g-oral glucose tolerance test: 3.5 mM; glycated haemoglobin A1c: 5.5%) during glucagon (1 mg) and meal (2,370 kJ) tests, and during two 2 h 15 mM-hyperglycaemic clamps with continuous intravenous infusion of glucagon-like peptide-1 (1 pmol/kg/min) and glucose-dependent insulinotropic polypeptide (4 pmol/kg/min), respectively. Normal insulin and C-peptide responses were observed during meal test (peak concentrations: 300 and 3,278 pM) and glucagontest (peak concentrations: 250 and 2,483 pM). During the hyperglycaemic clamp with continuous intravenous infusion of GLP-1 the subject exhibited plasma insulin and C-peptide concentrations of 13,770 and 22,380 pM, respectively. CONCLUSIONS: To our knowledge insulin and C-peptide concentrations of these magnitudes have never been reported. Thus, the present data support the view that glucagon-like peptide-1 is one of the most insulinotropic substances known.

Knop, Filip K; Lund, Asger

2014-01-01

 
 
 
 
41

Effects of Prolonged Glucose Infusion on Insulin Signal Transduction and Glucose Transport in Rat Skeletal Muscle  

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Glucose toxicity represents a well-established term referring to hyperglycemia as a potent contributor to the impairment of insulin action on insulin sensitive tissue. We set up an animal model to investigate the in vivo effects of glucose infusion on insulin signaling. Chronic catheter were implanted via right jugular vein into right atrium, routed subcutaneously and externalized between the shoulders to be connected to a Perfusor syringe pump. After a recovery period of 48 h, glucose (50...

Houdali, Basel

2000-01-01

42

Nuclearmedical investigations on tissue concentration and hemodynamic effects of retrograde intravenous pressure infusion  

International Nuclear Information System (INIS)

In 12 patients with trophic foot-lesions (diabetic feet) retrograde intravenous pressure infusions (150 ml) containing radioactive tracers (99m Tc, 99m Tc labelled human serum albumin) were carried out. With the veins emptied time-activity curves over the legs reflect tissue concentrations after release of the occlusion. Tissue-concentration is about 3 times higher than after intraarterial and 7 times higher than after intravenous injection of the same dose. The high count-rates which can be measured in the wound-secretion demonstrate the 'rinsing effect' of the injected fluid. Hemodynamic investigations have been performed in a double blind study. 8 patients received buflomedil and 9 got placebo 3 times per week by retrograde intravenous pressure infusions. After 3 weeks there was an increase of the peak-flow on the lower leg (venous occlusion plethysmography), an increase of transcutaneous oxygen pressure and a fall of peak flow-time and of plasma-viscosity, both for buflomedil and for placebo (without statistical significance): Preliminary investigations after an arterial occlusion for 1 hour showed an increase of flow-values measured by venous occlusion plethysmography which reached a maximum after 4 to 5 days

43

Intraperitoneal insulin delivery to patients with type 1 diabetes results in higher serum IGF-I bioactivity than continuous subcutaneous insulin infusion  

DEFF Research Database (Denmark)

Type 1 diabetes (T1D) is associated with low IGF-I and altered levels of IGF-binding proteins (IGFBPs) in plasma. This may be of importance for insulin sensitivity and the risk of developing diabetic complications. We hypothesized that IGF-I bioactivity is affected by the route of insulin administration and that continuous intraperitoneal insulin infusion (CIPII) has a more pronounced effect than continuous subcutaneous insulin infusion (CSII).

Hedman, Christina A; Frystyk, Jan

2013-01-01

44

Stroke volume and cardiac output hypoxemic hypoxia produced by intravenous infusion of carbon dioxide.  

Science.gov (United States)

Hypoxia produced by intravenous infusion of gaseous carbon dioxide was associated in conscious rabbits with decreases in cardiac output and stroke volume. At the same time the arterial blood pressure, oxygen uptake and blood pH decreased, whereas carbon dioxide pressure and lactate level in the arterial blood increased. Pulmonary ventilation increased too, due to the rise in the respiratory frequency and tidal volume. The fall in cardiac output and stroke volume explains a great fall of oxygen uptake in response to decrease of oxygen pressure in the blood. PMID:6787834

Lyszczarz, J; Boruta, E

1980-01-01

45

Pharmacokinetics of cefpimizole in normal humans after single- and multiple-dose intravenous infusions.  

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The pharmacokinetics of cefpimizole (free acid equivalents of cefpimizole sodium), a broad-spectrum cephalosporin antibiotic, were determined after single- and multiple-dose 20-min intravenous infusions of 1, 2, and 4 g. The kinetics of single-dose administration of cefpimizole correspond to a two-compartment model with an average apparent volume of distribution of 20.0 +/- 3.5 liters, a distribution rate constant of 2.24 +/- 1.00 h-1, and a terminal rate constant of 0.358 +/- 0.036 h-1 (half...

Lakings, D. B.; Friis, J. M.; Brown, R. J.; Allen, H. R.

1984-01-01

46

Differential effects of cranial radiation on growth hormone response to arginine and insulin infusion  

International Nuclear Information System (INIS)

The growth hormone responses to arginine infusion and to insulin-induced hypoglycemia were studied in 13 patients with neoplastic disease after treatment with radiation and chemotherapy. Patients who received intensive cranial radiation (greater than 2,400 rads) had no response to either arginine or insulin; those who received moderate cranial radiation (greater than or equal to 2,400 rads) had GH response to arginine but not to insulin; patients receiving no cranial radiation responded to both arginine and insulin. These data support the hypothesis that GH secretion in response to arginine infusion has a different mechanism in contrast to the response to insulin-induced hypoglycemia and that the latter is more vulnerable to cranial radiation

47

Effects of abomasal infusion of tallow or camelina oil on responses to glucose and insulin in dairy cows during late pregnancy.  

Science.gov (United States)

Late pregnancy is associated with moderate insulin resistance in ruminants. Reduced suppression of lipolysis by insulin facilitates mobilization of nonesterified fatty acids (NEFA) from adipose tissue, resulting in elevated plasma NEFA concentrations. Decrease in dry matter intake (DMI) before parturition leads to accelerated lipomobilization and increases plasma NEFA, which may further impair insulin sensitivity. The aim of the study was to evaluate the effects of elevation of plasma NEFA concentration by abomasal infusions tallow (TAL) or camelina oil (CAM) on whole-body responses to exogenous glucose and insulin. We further assessed whether CAM, rich in C18:3n-3, enhances whole-body insulin sensitivity compared with TAL. Six late-pregnant, second-parity, rumen-cannulated dry Ayrshire dairy cows fed grass silage to meet 95% of metabolizable energy requirements were used in a replicated 3 × 3 Latin square with 5-d periods and 5 recovery days between each period. Treatments consisted of abomasal infusion of 500 mL/d (430 g of lipids/d) of water (control), TAL, or CAM administered in 10 equal doses daily. Intravenous glucose tolerance test (IVGTT) and i.v. insulin challenge (IC) were performed on d 5 after 98 and 108 h of treatment infusions, respectively. Infusion of lipids increased basal plasma NEFA concentrations on d 5 (CAM: 0.25; TAL: 0.28; control: 0.17 mmol/L). Following glucose injection, the rate of glucose clearance (CR) was lower in lipid-treated cows (CAM: 1.34; TAL: 1.48; control: 1.74%/min) and time to reach half-maximal glucose concentration (T(1/2)) was longer (CAM: 54; TAL: 47; control: 42 min). Similar responses were observed after insulin injection. Increased plasma NEFA concentration tended to decrease insulin secretion in IVGTT. Infusion of CAM increased plasma C18:3n-3 content (CAM: 26.4; TAL: 16.1; control: 20.9 g/100g of fatty acids). Data suggest that CAM had an insulin-sensitizing effect, because the disposition index and insulin sensitivity index, derived from minimal model analysis, were higher in CAM than in TAL during IVGTT, and lower insulin concentrations during IC led to similar glucose clearance in CAM as in TAL. These results indicate that elevated plasma NEFA concentration per se induces whole-body insulin resistance in late-pregnant dry cows. PMID:22720937

Salin, S; Taponen, J; Elo, K; Simpura, I; Vanhatalo, A; Boston, R; Kokkonen, T

2012-07-01

48

Complications of continuous intraperitoneal insulin infusion with an implantable pump  

Science.gov (United States)

AIM: To monitor the course of continuous intraperitoneal insulin infusion (CIPII) and to gain more insight into possible complications. METHODS: A retrospective, longitudinal observational cohort study in patients with type 1 diabetes mellitus (T1DM) was performed. Only patients with “brittle” T1DM who started CIPII between January 1, 2000 and June 1, 2011, and were treated in the only centre in The Netherlands providing CIPII treatment (Isala clinics, Zwolle) were eligible for inclusion. Outcomes were defined as operation-free period (OFP), rate and type of complications. Subanalyses were made between patients starting CIPII from 2000 to 2007 and from 2007 onwards in order to study possible changes over time in complications and/or OFP. The OFP was calculated as the time from initial implantation to the date of first documented re-operation. If patients had not experienced an operation, their data were recorded at the date of last follow up or death. Kaplan-Meier curves were constructed to visualize the OFP. A (two-sided) P value of less than 0.05 was considered statistically significant. RESULTS: Fifty-seven patients were treated with CIPII, although one patient was excluded from analyses because of self-induced complications. In the remaining 56 patients, 70 complications occurred during 283 patient years. Catheter occlusion (32.9%), pump dysfunction (17.1%), pain at the pump site (15.7%) and infections (10.0%) were the most frequent complications. This resulted in a median OFP of 4.5 years (95% confidence interval 4.1-4.8 years) without any difference between the time periods. Fifty re-operations were performed because of complications, one per 5.6 patient years, with a decrease in pump dysfunction (P = 0.04) and pump explantations (P = 0.02) after 2007. In total, 9 episodes of ketoacidosis occurred during follow up and there were 69 hospital re-admissions, with a median duration of 6 d. CIPII was ceased in five patients due to recurrent infections (n = 2), pain (n = 1), inadequate glycaemic control (n = 1) or by own choice (n = 1). No CIPII related mortality was reported. CONCLUSION: The OFP has been stable over the last decade. No CIPII related mortality was reported. A significant decrease in pump dysfunction and explantation was seen after 2007 compared to the period 2000-2007. CIPII remains a safe treatment modality for specific patient groups. PMID:22912916

van Dijk, Peter R; Logtenberg, Susan JJ; Groenier, Klaas H; Haveman, Jan Willem; Kleefstra, Nanno; Bilo, Henk JG

2012-01-01

49

An experimental study of pulsed micro-flows pertinent to continuous subcutaneous insulin infusion therapy  

Science.gov (United States)

An experimental study was conducted to investigate the unsteady micro-flow driven by an insulin pump commonly used in continuous subcutaneous insulin infusion (CSII) therapy. A microscopic particle image velocimetry (PIV) system was used to characterize the transient behavior of the micro-flow upon the pulsed excitation of the insulin pump in order to elucidate the underlying physics for a better understanding of the microphysical process associated with the insulin delivery in CSII therapy. The effects of air bubbles entrained inside the micro-sized CSII tubing system on the insulin delivery process were also assessed based on the micro-PIV measurements. While most solutions to insulin occlusion-related problems are currently based on clinical trials, the findings derived from the present study can be used to provide a better guidance for the troubleshooting of insulin occlusion in CSII therapy.

Wang, Bin; Demuren, Ayodeji; Gyuricsko, Eric; Hu, Hui

2011-07-01

50

Portable detectors for 125I-insulin absorption measurement during subcutaneous infusion with portable pumps  

International Nuclear Information System (INIS)

Programmed subcutaneous insulin infusion is a promising method for normalisation of the blood glucose concentration in insulin-dependent diabetics. The absorption rate from the depot is usually measured intermittently by radioactively-labelled insulin and stationary scintillation detectors. Small portable detectors are an alternative, however, and continuous absorption measurements could be made during normal life conditions. Contrary to conventional single injection therapy, the insulin depot initially expands during infusion treatment, changing the geometry during measurements. In the present study the methodological aspects and geometrical dependences were investigated. Simulated studies were made with various plane disc 125I sources in Perspex phantoms as well as 125I-insulin absorption studies in short-term subcutaneous infusion experiments with anaesthetised rabbits. Results from portable, end-window Geiger-Mueller (GM) detectors fixed above the depots and close to the surfaces of phantom or skin were compared with results obtained by a conventional stationary NaI(Tl) detector 15 cm from the phantom or skin surface. With a 125I-insulin infusion site at 5 mm depth in the subcutaneous tissue of rabbits, an overall linear proportionality was found between the results obtained with a NaI(Tl) detector and a GM detector raised 15 mm above the skin surface inside the detector housing. (author)

51

Intravenous infusion of L-isomers of phenylalanine and tryptophan stimulate gastric acid secretion at physiologic plasma concentrations in normal subjects and after parietal cell vagotomy.  

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To determine whether intravenous infusion of individual amino acids stimulated gastric acid secretion in man, graded doses of phenylalanine, tryptophan, glycine, alanine, histidine, and NaCl control were infused on separate days in nine healthy subjects. Intravenous infusion of phenylalanine and tryptophan significantly stimulated gastric acid secretion to 50 and 52%, respectively, of the acid secretory response to intragastric peptone. Intravenous alanine and histidine were without effect, w...

Mcarthur, K. E.; Isenberg, J. I.; Hogan, D. L.; Dreier, S. J.

1983-01-01

52

Urinary iron excretion induced by intravenous infusion of deferoxamine in ß-thalassemia homozygous patients  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english The purpose of the present study was to identify noninvasive methods to evaluate the severity of iron overload in transfusion-dependent ß-thalassemia and the efficiency of intensive intravenous therapy as an additional tool for the treatment of iron-overloaded patients. Iron overload was evaluated f [...] or 26 ß-thalassemia homozygous patients, and 14 of them were submitted to intensive chelation therapy with high doses of intravenous deferoxamine (DF). Patients were classified into six groups of increasing clinical severity and were divided into compliant and non-compliant patients depending on their adherence to chronic chelation treatment. Several methods were used as indicators of iron overload. Total gain of transfusion iron, plasma ferritin, and urinary iron excretion in response to 20 to 60 mg/day subcutaneous DF for 8 to 12 h daily are useful to identify iron overload; however, urinary iron excretion in response to 9 g intravenous DF over 24 h and the increase of urinary iron excretion induced by high doses of the chelator are more reliable to identify different degrees of iron overload because of their correlation with the clinical grades of secondary hemochromatosis and the significant differences observed between the groups of compliant and non-compliant patients. Finally, the use of 3-9 g intravenous DF for 6-12 days led to a urinary iron excretion corresponding to 4.1 to 22.4% of the annual transfusion iron gain. Therefore, continuous intravenous DF at high doses may be an additional treatment for these patients, as a complement to the regular subcutaneous infusion at home, but requires individual planning and close monitoring of adverse reactions.

E., Boturão-Neto; L.F., Marcopito; M.A., Zago.

1319-13-01

53

Effects of the rate of insulin infusion during isoglycemic, hyperinsulinemic clamp procedures on measures of insulin action in healthy, mature thoroughbred mares.  

Science.gov (United States)

The objective of this study was to determine whether the rate of insulin infusion during isoglycemic hyperinsulinemic clamp procedures affected measures of insulin action, including glucose disposal and plasma non-esterified fatty acid, endothelin-1, and nitric oxide concentrations, in mature, healthy horses. Eight thoroughbred mares were studied during a 2-h hyperinsulinemic clamp procedure, conducted at each of 4 rates of insulin infusion: 0 (CON), 1.2 (LOWINS), 3 (MEDINS), and 6 (HIGHINS) mU · kg(-1) · min(-1). The infusion rate of a dextrose solution was adjusted throughout the clamp procedures to maintain blood glucose levels within 10% of baseline glucose concentrations. Plasma insulin concentrations were measured throughout the clamp procedures, and used with the rate of glucose infusion to calculate the plasma insulin concentration-to-rate of glucose infusion ratio, a measure of insulin action on glucose disposal. The rate of glucose infusion increased with rate of insulin infusion (P 0.05). The data indicate that it is important to standardize insulin infusion rate if data are to be compared between hyperinsulinemic clamp studies. PMID:24315754

Urschel, K L; Escobar, J; McCutcheon, L J; Geor, R J

2014-04-01

54

Effects of sitagliptin and metformin treatment on incretin hormone and insulin secretory responses to oral and "isoglycemic" intravenous glucose  

DEFF Research Database (Denmark)

Dipeptidyl peptidase-4 (DPP-4) inhibitors prevent degradation of incretin hormones (glucagon-like peptide 1 [GLP-1] and glucose-dependent insulinotropic polypeptide [GIP]), whereas metformin may increase GLP-1 levels. We examined, in a four-period crossover trial, the influence of metformin (2,000 mg/day), sitagliptin (100 mg/day), or their combination, on GLP-1 responses and on the incretin effect in 20 patients with type 2 diabetes, comparing an oral glucose challenge (75 g, day 5) and an "isoglycemic" intravenous glucose infusion (day 6). Fasting total GLP-1 was significantly increased by metformin and not changed by sitagliptin. After oral glucose, metformin increased and sitagliptin significantly decreased (by 53%) total GLP-1. Fasting and postload intact GLP-1 increased with sitagliptin but not with metformin. After oral glucose, only sitagliptin, but not metformin, significantly augmented insulin secretion, in monotherapy and as an add-on to metformin. The incretin effect was not changed numerically with any of the treatments. In conclusion, sitagliptin increased intact GLP-1 and GIP through DPP-4 inhibition but reduced total GLP-1 and GIP (feedback inhibition) without affecting the numerical contribution of the incretin effect. Insulin secretion with sitagliptin treatment was similarly stimulated with oral and "isoglycemic" intravenous glucose. This points to an important contribution of small changes in incretin concentrations within the basal range or to additional insulinotropic agents besides GLP mediating the antidiabetic effects of DPP-4 inhibition.

Vardarli, Irfan; Arndt, Elisabeth

2014-01-01

55

Effect of shorter term of intravenous infusion for reduction of catheter-related bloodstream infection after gastrectomy.  

Science.gov (United States)

After gastrectomy, a longer period of intravenous alimentation is required than for other digestive surgeries, portending a higher risk of catheter-related bloodstream infection (CRBSI). From assessment of CRBSI occurring between 2004 and 2007 (preintervention group), the duration of intravenous infusion between 2008 and 2010 (postintervention group) was changed to shorter-term (6-day) infusion. To verify the effect of changes in injection schedule on the incidence of CRBSI, the occurrence of CRBSI was studied comparatively among preintervention and postintervention cases, excluding cases requiring intravenous infusion preoperatively, and cases requiring long-term intravenous infusion postoperatively due to postoperative complications. The rate of CRBSI in the postintervention group (0%; 0 of 298) was significantly lower than that in the preintervention group (1.7%; 8 of 477; P = 0.026). There was no significant difference between preintervention and postintervention groups in postoperative complications. Six-day infusion decreased the incidence of CRBSI after gastrectomy significantly, without increasing postoperative complications. PMID:23294077

Kawamura, Hideki; Tanioka, Toshiro; Kuji, Mariko; Shibuya, Kazuaki; Takahashi, Masahiro

2012-01-01

56

The Experiences of School Nurses Caring for Students Receiving Continuous Subcutaneous Insulin Infusion Therapy  

Science.gov (United States)

Diabetes mellitus is the most common metabolic disorder in childhood. Today, children with diabetes are receiving new technologically advanced treatment options, such as continuous subcutaneous insulin infusion (CSII) therapy. School nurses are the primary health caregivers of children with diabetes during school hours. Therefore, it is important…

Darby, Wendy

2006-01-01

57

Explorative study of pharmacokinetics and pharmacodynamics after change in Basal insulin infusion rate  

DEFF Research Database (Denmark)

The use of insulin pumps is rapidly increasing and new, technologically more advanced pumps are continuously being developed. It is of interest to assess the clinical relevance of the many technical features of these pumps, e.g., the effect on pharmacokinetics and pharmacodynamics with change in infusion rate.

Ihlo, Charlotte A; Lauritzen, Torsten

2011-01-01

58

Response of colo-rectal hepatic metastases to concomitant radiotherapy and intravenous infusion 5 fluorouracil  

International Nuclear Information System (INIS)

Twenty-three patients with colo-rectal hepatic metastases were retrospectively reviewed after completing treatment with split course liver irradiation and continually infused concomitant intravenous 5-fluorouracil. Although no patient attained a complete response, an objective partial response was documented in 15 (Responders). The Responders had a median survival of 45 weeks whereas Non-responders had a median survival of 17 weeks. Patients with metastatic disease solely in the liver or those with a Karnofsky performance score (k.p.s) of over sixty, had a median survival of 49 weeks. Patients with multiple organ metastatic involvement had a median survival of 25 weeks and those with a Karnofsky with less than 60 had a median survival of 27 weeks. (p values of 0.006 and 0.03, respectively.) The overall survival of the group completing treatment was 30 weeks, and 19 patients (83%) achieved subjective palliation. The patients tolerated therapy well. There was minimal hematological toxicity; 3 patients developed a leucocyte count of less than 2000 and 1 developed a platelet count of 30,000. The palliation and prolongation of survival attained with minimal complications suggest that adjuvant liver irradiation with concomitant infusion 5-fluorouracil radiosensitization may be an option to offer patients identified to be at high risk of developing subclinical liver disease

59

Effect of glucose and insulin infusion on the myocardial extraction of a radioiodinated methyl-substituted fatty acid  

International Nuclear Information System (INIS)

We investigated the one-way. An extraction of 14-iodophenyl-tetradecanoic acid (BMTDA) in the canine heart under fasting conditions and during infusion of glucose plus insulin in eight an esthetized greyhound dogs. Myocardial extraction measurements were made with dual tracer approach, using Tc-99m albumin as reference tracer. Prior to, and during, infusion of 10% glucose and 25 units of regular insulin, heart rate, blood pressure, plasma glucose, insulin and free fatty acid levels were measured. Myocardial blood flow was determined using Sn-113 and Ru-103 radioactive microspheres. The mean extraction fraction of BMTDA was 0.38+-SEM 0.06 at baseline and increased to 0.44+-0.06 during hyperglycemia plus insulin (P<0.025). Plasma glucose and insulin were higher during the infusion (P<0.01) while plasma free fatty acids significantly declined (P<0.01). There were no changes in hemodynamics or myocardial blood flow during the infusion. We conclude that glucose and insulin infusion result in increased first-pass extraction fraction of radioiodinated BMTDA unaccompanied by changes in coronary flow or hemodynamics, implying an insulin-mediated augmented transport of BMTDA. (orig.)

60

Usefulness of Intravenous Anesthesia Using a Target-controlled Infusion System with Local Anesthesia in Submuscular Breast Augmentation Surgery  

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Background Patients have anxiety and fear of complications due to general anesthesia.Through new instruments and local anesthetic drugs, a variety of anesthetic methods havebeen introduced. These methods keep hospital costs down and save time for patients. Inparticular, the target-controlled infusion (TCI) system maintains a relatively accurate level ofplasma concentration, so the depth of anesthesia can be adjusted more easily. We conductedthis study to examine whether intravenous anesthesia...

Kyu-Jin Chung; Kyu-Ho Cha; Jun-Ho Lee; Yong-Ha Kim; Tae-Gon Kim; Il-Guk Kim

2012-01-01

 
 
 
 
61

Hypocaloric enteral nutrition protects against hypoglycemia associated with intensive insulin therapy better than intravenous dextrose.  

Science.gov (United States)

Intensive insulin therapy treats hyperglycemia but increases the risk of hypoglycemia. Typically, intravenous dextrose is given to prevent hypoglycemia; however, enteral nutrition is preferred. We hypothesized that the provision of hypocaloric enteral nutrition would protect against hypoglycemia. A retrospective analysis was performed evaluating patients treated with intensive insulin therapy comparing the use of enteral nutrition versus a dextrose-only intravenous solution. Nutrition in the 2 hours before each blood glucose test was assessed, and the association with hypoglycemia (50 mg/dL or less) evaluated. Risk of hypoglycemia as a function of nutrition type and rate was estimated by multivariable regression. A total of 26,140 blood glucose tests were collected on 1289 patients. Hypoglycemia occurred in 6.4 per cent of patients. In regression models, enteral nutrition was the strongest protective factor against hypoglycemia (P < 0.001) with the largest risk reduction (steepest portion of the curve) occurring at 60 per cent goal. Hypocaloric enteral nutrition showed a greater risk reduction than a peripheral dextrose-only intravenous solution alone. In the setting of intensive insulin therapy, the provision of enteral nutrition, even if hypocaloric, is sufficient to protect against hypoglycemia. Future prospective studies should evaluate the efficacy of enteral nutrition in reducing the risk of hypoglycemia and whether lower rates of hypoglycemia correspond to improved outcomes. PMID:25347500

Kauffmann, Rondi M; Hayes, Rachel M; VanLaeken, Amanda H; Norris, Patrick R; Diaz, Jose J; May, Addison K; Collier, Bryan R

2014-11-01

62

Overnight versus 24 hours of continuous subcutaneous insulin infusion as supplement to oral antidiabetic drugs in type 2 diabetes  

DEFF Research Database (Denmark)

Basal continuous subcutaneous insulin infusion (CSII) therapy at a fixed rate may effectively improve glycemic control in patients with type 2 diabetes when oral antidiabetic treatment fails. Regimens of simple constant subcutaneous delivery of insulin may provide theoretical advantages in type 2 diabetes.

Parkner, Tina; Laursen, Torben

2007-01-01

63

Design of a safer approach to intravenous drug infusions: failure mode effects analysis  

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Objectives: A set of standard processes was developed for delivering continuous drug infusions in order to improve (1) patient safety; (2) efficiency in staff workflow; (3) hemodynamic stability during infusion changes, and (4) efficient use of resources. Failure modes effects analysis (FMEA) was used to examine the impact of process changes on the reliability of delivering drug infusions.

Apkon, M.; Leonard, J.; Probst, L.; Delizio, L.; Vitale, R.

2004-01-01

64

Continuous subcutaneous insulin infusion and multiple dose insulin injections in Type 1 diabetic pregnant women: a case-control study.  

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The aim of this study was to evaluate the effects of continuous subcutaneous insulin infusion (CSII) on glycemic control and pregnancy outcomes in Type 1 diabetic pregnant women. We retrospectively evaluated 42 subjects, 20 treated with CSII and 22 with multiple dose insulin injections (MDI). The two groups were comparable for age, pre-pregnancy BMI, and primiparous rate, whereas women in the CSII group showed a tendency toward a longer diabetes duration (p = 0.06). Pre-pregnancy diabetic retinopathy and/or nephropathy were present in nine women of CSII and three of MDI. In all women metabolic control improved during pregnancy, without differences between the two groups and at the end of gestation HbA1c was 6.3 +/- 0.6 in CSII and 6.1 +/- 1.1% in MDI. Moreover, there were no differences in weight gain, whereas insulin requirement resulted significantly (p = 0.009) lower in CSII than in MDI. We recorded only one severe hypoglycaemic episode in both groups. No cases of deteriorations of the chronic diabetic complications were observed. The delivery occurred at 36.4 +/- 2.2 weeks; birth weight, the rate of large for gestational age, and the parameters of foetal morbidity were similar in both groups. In conclusions, CSII and MDI are both effective in improving maternal glucose control and have both similar pregnancy outcomes. PMID:19728190

Volpe, Laura; Pancani, Francesca; Aragona, Michele; Lencioni, Cristina; Battini, Lorella; Ghio, Alessandra; Resi, Veronica; Bertolotto, Alessandra; Del Prato, Stefano; Di Cianni, Graziano

2010-03-01

65

Modelling the Effect of Exercise on Insulin Pharmacokinetics in "Continuous Subcutaneous Insulin Infusion" Treated Type 1 Diabetes Patients  

DEFF Research Database (Denmark)

Introduction: The artificial pancreas is believed to ease the burden of constant management of type 1 diabetes for the patients substantially. An important aspect of the artificial pancreas development is the mathematical models used for control, prediction or simulation. A major challenge to the realization of the artificial pancreas is the effect of exercise on the insulin and plasma glucose dynamics. In this report, we take the first step towards a population model of exercise effects in type 1 diabetes. We focus on the effect on the insulin pharmacokinetics in continuous subcutaneous insulin infusion (CSII) treated patients by modelling the absorption rate as a function of exercise. Methods: Three models are estimated from 17 data sequences. All of them are based on a linear three-compartment base model. The models are based on stochastic differential equations to allow noise to enter the dynamics. In the first model, the insulin absorption rate parameter is replaced by a random walk. In the second model, the relationship between the absorption rate and exercise is modelled as a linear dependency, while in the third model this linear relationship depends on the intensity. A Lamperti transformation is used to ensure non-negative state values. A special focus is put on the structural identiflability of the base model, while the posterior identiflability is checked for all models from the conditional likelihood profiles. Results: The first model is disregarded due to the small number of observations during the exercise bout. From likelihood-ratio tests and information criteria, the third model is appointed as the best model to model the relationship between exercise and the insulin absorption. The posterior identiflability check showed that it was not possible to identify the variance of the measurement variance. Conclusion: A model to predict the insulin appearance in plasma during exercise in CSII treated patients is identified. Further clinical studies are needed to confirm the increase in insulin plasma concentration during exercise in type 1 diabetes patients. These studies should include dense sampling to allow for a fully data driven identification of an appropriate model.

Duun-Henriksen, Anne Katrine; Juhl, Rune

2013-01-01

66

A Case of Malignant Melanoma with In-Transit Metastasis That Responded to Intravenous Infusion of Interferon-?.  

Science.gov (United States)

A 77-year-old man with a history of surgical resection of malignant melanoma involving the fifth toe of his left foot 14 years ago presented at the Kariya Toyota General Hospital with a 3-month history of skin ulcer at the same site and red nodules on the lower left leg. Malignant melanoma was suspected, and the patient was referred to our department. On examination, a skin ulcer measuring 25 × 20 mm was observed at the amputation site on the left foot. In addition, multiple red nodules were observed on the lower left leg. Skin biopsies of the ulcer and nodules revealed recurrent malignant melanoma with in-transit metastasis. Two weeks later, he developed acute myocardial infarction and was hospitalized at the Kariya Toyota General Hospital. One month later, the myocardial infarction ameliorated, and he was transferred to our department. As the myocardial infarction had decreased the patient's tolerance to surgery, interferon-? was administered by intravenous infusion. The skin ulcer and red nodules on the lower left leg disappeared 26 weeks after infusion had been initiated. The patient's progress has been satisfactory, with no evidence of recurrence or metastasis at 1 year and 9 months after the initiation of intravenous infusion. PMID:24707255

Arima, Masaru; Iwata, Youhei; Morita, Yusuke; Kobayashi, Tsukane; Sasaki, Ryousuke; Suzuki, Kayoko; Matsunaga, Kayoko

2014-01-01

67

Intravenous infusions of nifedipine: an alternative for the prevention of hypertension in eye surgery under local anesthesia.  

Science.gov (United States)

In order to control critical rises of blood pressure during the peri-operative period in elderly hypertensive patients, the effectiveness of a continuous intravenous infusion of nifedipine was studied. In a double blind study, patients (n = 60) who underwent eye surgery under local anesthesia were divided randomly into three groups. Patients who were found to have 200 > SBP > 160 and 120 > DBP > 90 mmHg as the previous day of surgery, as well as patients who did not receive any anti-hypertensive treatment regimen during the last week before surgery, were selected. Five min before performing local anesthesia, a continuous infusion of nifedipine at two different rates of 0.65 mg/h and 1.25 mg/h, was administered in groups A and B respectively, whereas group C received a placebo. SBP, DBP and HR were recorded every 5 min. for an hour. Statistically significant differences among the profiles of the three groups were found. The control group had a higher SBP/DBP. None of the groups, showed significant changes in HR. In conclusion, the intravenous infusion of nifedipine in a dose 1.25 mg/h, seems to control the hypertensive phases of blood pressure, without dropping to any unduly low level, risking undesirable side effects in elderly hypertensive patients during perioperative period. PMID:9259871

Nastou, H; Sarros, G; Nastos, A; Saleh, M

1997-01-01

68

A Case of Malignant Melanoma with In-Transit Metastasis That Responded to Intravenous Infusion of Interferon-?  

Science.gov (United States)

A 77-year-old man with a history of surgical resection of malignant melanoma involving the fifth toe of his left foot 14 years ago presented at the Kariya Toyota General Hospital with a 3-month history of skin ulcer at the same site and red nodules on the lower left leg. Malignant melanoma was suspected, and the patient was referred to our department. On examination, a skin ulcer measuring 25 × 20 mm was observed at the amputation site on the left foot. In addition, multiple red nodules were observed on the lower left leg. Skin biopsies of the ulcer and nodules revealed recurrent malignant melanoma with in-transit metastasis. Two weeks later, he developed acute myocardial infarction and was hospitalized at the Kariya Toyota General Hospital. One month later, the myocardial infarction ameliorated, and he was transferred to our department. As the myocardial infarction had decreased the patient's tolerance to surgery, interferon-? was administered by intravenous infusion. The skin ulcer and red nodules on the lower left leg disappeared 26 weeks after infusion had been initiated. The patient's progress has been satisfactory, with no evidence of recurrence or metastasis at 1 year and 9 months after the initiation of intravenous infusion. PMID:24707255

Arima, Masaru; Iwata, Youhei; Morita, Yusuke; Kobayashi, Tsukane; Sasaki, Ryousuke; Suzuki, Kayoko; Matsunaga, Kayoko

2014-01-01

69

Influence of insulin antibodies on pharmacokinetics and bioavailability of recombinant human and highly purified beef insulins in insulin dependent diabetics.  

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Sixteen insulin dependent diabetics of long standing, with undetectable fasting plasma C peptide concentrations, and eight non-diabetic controls were each infused intravenously with biosynthetic human and highly purified beef insulin (1 mU/kg/min) while euglycaemia was maintained by a Biostator. No difference was observed between the two insulins in respect of insulin pharmacokinetics or biological action. The diabetics showed appreciable insulin resistance, manifested by a 40% reduction in t...

Gray, R. S.; Cowan, P.; Di Mario, U.; Elton, R. A.; Clarke, B. F.; Duncan, L. J.

1985-01-01

70

Pharmacokinetics and tolerance of toal astragalosides after intravenous infusion of astragalosides injection in healthy Chinese volunteers.  

Science.gov (United States)

Total astragalosides (TA) are the principal active constituents isolated from Radix Astragali, which has been extensively used in the traditional Chinese medicine for hundreds of years. However, few detailed pharmacokinetic studies about TA or its main component in human have been done to date. The aim of this study was to investigate the pharmacokinetic (PK) characteristics of astragaloside IV (AGS-IV), the primary ingredient of TA, and tolerance of TA after single- and multi-intravenous infusion of astragalosides injection (AI) in healthy Chinese volunteers. A LC-MS/MS assay was developed for AGS-IV determination in human plasma and urine, and the PK parameters were estimated using non-compartmental methods. The mean maximum plasma concentration (Cmax) values of AGS-IV were 2.12, 3.59, 3.71 and 5.17 ?g ml(-1) after single doses of 200, 300, 400 and 500 ml of AI, respectively. The corresponding mean values of area under the plasma concentration (AUC(0-?)) were 4.38, 9.75, 13.59 and 18.22 ?g h ml(-1), respectively, and the mean values of elimination half-life (t1/2) were 2.14, 2.59, 2.62 and 2.69 h, respectively. In the repeated dose study, no significant difference was observed between the PK parameters, peak time (Tmax), t1/2 and AUC, of day 1 and day 7. Cumulative urinary excretion of AGS-IV was 3.91% within 24 h after administration of 500 ml AI. AI was safe and well tolerated, and the adverse events, such as raised total bilirubin and rash, were mild and resolved spontaneously. In summary, the pharmacokinetic properties of AGS-IV are based on linear pharmacokinetics over the doses ranging from 200 to 500 ml of AI. No accumulation of AGS-IV was observed after repeated administration of AI once daily. AI was safe and well tolerated in this study, although cases of transient adverse events were observed. PMID:23838148

Xu, Meijuan; Yin, Jungang; Xie, Liyan; Zhang, Jun; Zou, Chong; Zou, Jiandong; Liu, Fang; Ju, Wenzheng; Li, Ping

2013-09-15

71

Central infusion of ketone bodies modulates body weight and hepatic insulin sensitivity by modifying hypothalamic leptin and insulin signaling pathways in type 2 diabetic rats.  

Science.gov (United States)

Although the effects of ketogenic diets on energy and glucose homeostasis have been controversial, elevation of serum ketone levels by subcutaneous injection of ?-hydroxybutyrate (BHB) can improve glucose homeostasis. Ketones may work through the brain; therefore, we evaluated whether the intracerebroventricular (ICV) infusion of ?-hydroxybutyrates would also modulate peripheral energy and glucose homeostasis, and through what mechanisms, in diabetic rats fed a high fat diet in short- and long-term studies. Short-term (3h) central injection of BHB (50 ?g/h) improved serum glucose levels and peripheral insulin sensitivity compared to the artificial cerebrospinal fluid (CSF) group among 90% pancreatectomized (Px) diabetic rats, but not in non-diabetic Sham rats. In addition to short-term infusion, long-term (28 days) central infusion of BHB (12 ?g/h) elevated serum BHB levels. Long-term infusion of BHB potentiated leptin and insulin signaling in the hypothalamus to slightly decrease body weight in Px rats. Central BHB infusion had a greater effect on peripheral glucose metabolism than overall energy metabolism. Hepatic insulin signaling (tyrosine phosphorylation of IRS2?serine phosphorylation of Akt?reduced expression of PEPCK) was potentiated and hepatic glucose production in the hyperinsulinemic state was suppressed in the diabetic rats. In addition, glucose tolerance was improved by central BHB infusion through enhanced whole body glucose disposal rates, but insulin secretion was not affected in the diabetic rats. In conclusion, mild ketosis by central infusion of ketones improves energy and glucose metabolism through the potentiation of leptin and insulin signaling in the hypothalamus of diabetic rats. PMID:21652033

Park, Sunmin; Kim, Da Sol; Daily, James W

2011-07-15

72

The comparison of 5-Fu pharmacokinetics on rabbit after left gastric intraarterial infusion and by peripheral intravenous administration  

International Nuclear Information System (INIS)

Objective: To compare the pharmacokinetics on rabbit after left gastric regional arterial infusion chemotherapy with peripheral intravenous administration. Methods: 18 rabbits were separated into 6 time-groups at random and 5-Fu (50 mg/kg) was infused through left gastric artery. Blood of portal vein and peripheral vein were sampled at different time. Finally all rabbits were killed and partial stomach tissues were sampled. Blood and stomach tissue were analysed with high efficacy liquid chromatography after disposed. Control group members were infused 5-Fu (50 mg/kg) by ear marginal vein and then blood and stomach tissue samples taken at different times were analysed with the same method. Results: The drug concentration-time curve of portal vein and peripheral vein both reached the peak at the fifth minute after drug administration in the two methods, then declined quickly and slowed down after 30 minutes, according with two-house models. The drug concentration in portal vein of the experimental group was obviously higher than in the peripheral vein and also higher than in the portal vein of the control group maintaining for a longer period. Drug concentration in stomach tissue of experimental group was 11 times of that of control group at the fifth minute and was similar after 2 hours in both methods groups. Conclusions: Drug concentration in blood of portal vein and stomach tissue can maintain a higher level in a longer period with the same local effect after left gastric arterial infusion chemotherapy showing high chemotherapeutic efficiency

73

Renal response to intravenous somatostatin in insulin-dependent diabetic patients and normal subjects  

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The acute effects of iv somatostatin (SRIH; 100 micrograms/h) on the urinary flow (Uvol), effective renal plasma flow (RPF), and glomerular filtration rate (GFR) were compared with those of a control infusion of 0.15 M NaCl in nine insulin-dependent diabetic (IDD) patients of less than 10 yr disease duration and six normal subjects (NS). RPF and GFR were measured using a standard primed constant isotope infusion of (/sup 125/I)iodohippurate and (51Cr)chromium EDTA. Uvol, RPF, and GFR were measured during 20-min clearance periods. During the NaCl infusion mean Uvol, RPF, and GFR were 14.1 +/- 0.2 (+/- SEM), 708 +/- 4, and 150 +/- 1 mL/min in the IDD group and 12.7 +/- 0.4, 568 +/- 5, and 110 +/- 2 mL/min in the NS group, respectively. In the IDD patients Uvol, RPF, and GFR decreased from 16.6 +/- 1.8, 670 +/- 30, 146 +/- 4 mL/min pre-SRIH to 9.2 +/- 1, 553 +/- 25 (P less than 0.001), and 130 +/- 5 mL/min, respectively, at 120 min during the SRIH infusion. Similarly, in the NS group mean Uvol, RPF, and GFR were 14.2 +/- 0.6, 552 +/- 15, and 112 +/- 5 mL/min pre-SRIH and decreased to 7.4 +/- 0.6, 422 +/- 7, and 93 +/- 3 mL/min, respectively, after 120 min of the SRIH infusion. SRIH, therefore, had a profound effect on renal function in both IDD patients and NS, resulting in a reduction in RPF, GFR, and, as a consequence, Uvol.

Vora, J.; Owens, D.R.; Luzio, S.; Atiea, J.; Ryder, R.; Hayes, T.M.

1987-05-01

74

Consumption of Ocimum sanctum L. and Citrus paradisi infusions modulates lipid metabolism and insulin resistance in obese rats.  

Science.gov (United States)

A high saturated fat and fructose diet leads to metabolic disorders through dysregulation of genes involved in lipid metabolism. Consumption of plant infusions reduces these obesity alterations, but the precise mechanism remains unclear. In this study, we investigated the effect and the possible mechanism of Ocimum sanctum L. (OS) and Citrus paradisi (CP) infusions in diet-induced obese rats. CP and OS infusions suppressed hepatic tissue fat accumulation, and significantly down-regulated the mRNA levels of two hepatic lipogenesis genes: sterol regulatory element binding protein 1c (SREBP1c) and fatty acid synthase (FAS) compared with the obese control. Treatment with these infusions up-regulated the hepatic expression of mRNA related to mitochondrial fatty acid uptake: peroxisome proliferator activated receptor alpha (PPAR?) and the expression of carnitine palmitoyl-transferase 1a (CPT1a). Both infusions improved insulin resistance, with OS showing the major effect. Consumption of these infusions reduces the damage caused by free radicals, protecting hepatic lipids and proteins. Additionally, plant infusions increase activity of hepatic enzymes: glutathione S-transferase (GST), glutathione peroxidase (GPX), and catalase (CAT). Our results suggest that the effects of CP and OS infusions on lipid metabolism are related to the down-regulation of genes involved in lipogenesis, particularly for OS, and to the increase in lipid ?-oxidation, especially for CP infusion. In conclusion, the consumption of these plant infusions is a feasible adjuvant therapy for metabolic changes induced by obesity. PMID:24584283

Gamboa-Gómez, Claudia; Salgado, Luis M; González-Gallardo, Adriana; Ramos-Gómez, Minerva; Loarca-Piña, Guadalupe; Reynoso-Camacho, Rosalía

2014-05-01

75

Chemotherapy administered using two-route infusion of cisplatin and sodium thiosulfate and intravenous infusion of vinblastine and peplomycin in patients with oral cancer.  

Science.gov (United States)

The therapeutic effects of neo-adjuvant chemotherapy administered by two-route infusion of cisplatin and its antidote, sodium thiosulfate, and intravenous infusion of vinblastine and peplomycin were studied in 22 patients with previously untreated squamous cell carcinoma of the oral cavity or maxillary sinus. The overall response rate to chemotherapy was 90.9%, with a complete response in 12 patients (54.5%), a partial response in 8 patients (36.4%), and no change in 2 patients (9.1%). Histologic assessment showed a grade V response in 7 patients (31.8%), grade IV in 3 patients (13.6%), grade III in 5 patients (22.7%), grade II in 4 patients (18.2%), and grade I in 3 patients (13.6%). The cumulative 5-year survival rate, including 3 patients who died of another disease, was 72.2%. Leukocytopenia, an important side effect apparently induced by vinblastine, was seen, but no life-threatening complications occurred. Renal toxicity by cisplatin was minimal because of the use of sodium thiosulfate and fosfomycin. These data indicate that this mode of chemotherapy may be more effective for treating head and neck cancer than ordinary chemotherapy, from clinical and histologic standpoints. The high complete-response rate is especially noteworthy. No serious side effects or reductions in treatment period occurred. The results are preliminary and additional studies using a larger patient population are needed. PMID:7614528

Wada, T; Harada, M; Morita, N; Oomata, T; Koizumi, T; Kawashima, T; Sakamoto, T

1995-01-01

76

Short-lasting systemic and regional benefits of early crystalloid infusion after intravenous inoculation of dogs with live Escherichia coli  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english We investigated the systemic and regional hemodynamic effects of early crystalloid infusion in an experimental model of septic shock induced by intravenous inoculation with live Escherichia coli. Anesthetized dogs received an intravenous infusion of 1.2 x 10(10) cfu/kg live E. coli in 30 min. After [...] 30 min of observation, they were randomized to controls (no fluids; N = 7), or fluid resuscitation with lactated Ringer's solution, 16 ml/kg (N = 7) or 32 ml/kg (N = 7) over 30 min and followed for 120 min. Cardiac index, portal blood flow, mean arterial pressure, systemic and regional oxygen-derived variables, blood lactate, and gastric PCO2 were assessed. Rapid and progressive cardiovascular deterioration with reduction in cardiac output, mean arterial pressure and portal blood flow (~50, ~25 and ~70%, respectively) was induced by the live bacteria challenge. Systemic and regional territories showed significant increases in oxygen extraction and in lactate levels. Significant increases in venous-arterial (~9.6 mmHg), portal-arterial (~12.1 mmHg) and gastric mucosal-arterial (~18.4 mmHg) PCO2 gradients were also observed. Early fluid replacement, especially with 32 ml/kg volumes of crystalloids, promoted only partial and transient benefits such as increases of ~76% in cardiac index, of ~50% in portal vein blood flow and decreases in venous-arterial, portal-arterial, gastric mucosal-arterial PCO2 gradients (7.2 ± 1.0, 7.2 ± 1.3 and 9.7 ± 2.5 mmHg, respectively). The fluid infusion promoted only modest and transient benefits, unable to restore the systemic and regional perfusional and metabolic changes in this hypodynamic septic shock model.

A.G., Garrido; L.F., Poli de Figueiredo; R.J., Cruz Jr.; E., Silva; M., Rocha e Silva.

2005-06-01

77

Acute hypoglycemic, hypocholesterolemic and hypotriglyceridemic effects of continuous intravenous infusion of a lyophilised aqueous extract of Ajuga iva L. Schreber whole plant in streptozotocin-induced diabetic rats.  

Science.gov (United States)

The hypoglycemic and hypolipidemic effect of continuous intravenous infusion of a lyophilised aqueous extract of the whole plant Ajuga iva (L.) Schreber (Labiatae) (AI-extract) was investigated in anesthetized normal and streptozotocin (STZ)-induced diabetic rats. The AI-extract was administered to a group of rats by continuous intravenous infusion for 4 h at a dose of 4.2 microg/min/100 g body weight; another group was infused with taurine, the reference compound, at the same dose. In normal rats, AI-extract infusion had no effect on plasma glucose or triglycerides, but plasma cholesterol levels were significantly decreased (22%; Pcholesterol by 35% (Pcholesterol (54%; PAjuga iva appears to be a useful plant in the therapy of diabetes, a condition in which hyperglycemia and dyslipidemia coexist quite often. PMID:17604246

El-Hilaly, Jaouad; Tahraoui, Adil; Israili, Zafar H; Lyoussi, Badiâa

2007-10-01

78

Maintenance time of sedative effects after an intravenous infusion of diazepam: A guide for endoscopy using diazepam  

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Full Text Available AIM: To examine whether the sedative effects assessed by psychomotor tests would depend on the cytochrome P450 (CYP 2C19 genotypes after an infusion regimen of diazepam commonly used for gastrointestinal endoscopy in Japan.METHODS: Fifteen healthy Japanese volunteers consisting of three different CYP2C19 genotype groups underwent a critical flicker fusion test, an eye movement analysis and a postural sway test as a test for physical sedative effects, and a visual analog scale (VAS symptom assessment method as a test for mental sedative effects during the 336 h period after the intravenous infusion of diazepam (5 mg.RESULTS: The physical sedative effects assessed by the critical flicker test continued for 1 h (t values of 5 min, 30 min and 60 min later: 4.35, 5.00 and 3.19, respectively and those by the moving radial area of a postural sway test continued for 3 h (t values of 5 h, 30 h, 60 min and 3 h later: -4.05, -3.42, -2.17 and -2.58, respectively, which changed significantly compared with the baseline level before infusion (P < 0.05. On the other hand, the mental sedative effects by the VAS method improved within 1 h. The CYP2C19 genotype-dependent differences in the postinfusion sedative effects were not observed in any of the four psychomotor function tests.CONCLUSION: With the psychomotor tests, the objective sedative effects of diazepam continued for 1 h to 3 h irrespective of CYP2C19 genotype status and the subjective sedative symptoms improved within 1 h. Up to 3 h of clinical care appears to be required after the infusion of diazepam, although patients feel subjectively improved.

Mitsushige Sugimoto, Takahisa Furuta, Akiko Nakamura, Naohito Shirai, Mutsuhiro Ikuma, Shingen Misaka, Shinya Uchida, Hiroshi Watanabe, Kyoichi Ohashi, Takashi Ishizaki, Akira Hishida

2008-09-01

79

Response of circulating somatostatin, insulin, gastrin and GIP, to intraduodenal infusion of nutrients in normal man.  

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We have studied the effect of direct infusion of nutrients into the duodenum of normal subjects on circulating plasma somatostatin, insulin, gastrin and gastric inhibitory polypeptide (GIP) levels. Six normal subjects were given on four separate occasions 150 ml of isotonic solutions containing 100 calories of carbohydrate, protein, or fat, and a control solution of saline, by infusion into the second part of the duodenum. Plasma somatostatin rose slightly after carbohydrate, mean basal 30 +/- 3 pg/ml, peak 46 +/- 16 pg/ml at 15 min; and more markedly after protein, peak 57 +/- 9 pg/ml at 30 min. However, fat was the most potent intraduodenal stimulus to plasma somatostatin release into circulation, peak 101 +/- 11 pg/ml at 30 min. The plasma insulin rise was greatest after carbohydrate, peak 68 +/- 10 i.u., but there was a significant rise after protein also, peak 34 +/- 6 i.u. Plasma gastrin rose significantly after protein only, peak 70 +/- 22 pg/ml. Plasma GIP rose markedly after carbohydrate, basal 506 +/- 50 pg/ml, peak 1480 +/- 120 pg/ml. Protein was also a potent stimulus of circulating plasma GIP release, peak 1200 +/- 190 pg/ml, while fat was the least potent, peak 730 +/- 190 pg/ml. Thus, calorie for calorie, fat is the most potent intraduodenal nutrient stimulus of circulating somatostatin. We postulate therefore that somatostatin may be an enterogastrone--a circulating hormone released by intraduodenal fat which inhibits gastric acid secretion. Fat is the least potent intraduodenal nutrient stimulus of circulating GIP release. This is evidence against the hypothesis that circulating GIP acts as an enterogastrone. PMID:6148162

Lucey, M R; Fairclough, P D; Wass, J A; Kwasowski, P; Medbak, S; Webb, J; Rees, L H

1984-09-01

80

Effect of perioperative insulin infusion on surgical morbidity and mortality: systematic review and meta-analysis of randomized trials.7  

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OBJECTIVE: To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of perioperative insulin infusion on outcomes important to patients. PATIENTS AND METHODS: We used 6 search strategies including an electronic database search of MEDLINE, EMBASE, and Cochrane CENTRAL, from their inception up to May 1, 2006, and included RCTs of perioperative insulin infusion (with or without glucose targets) measuring outcomes in patients undergoing any surgery. Pairs of reviewers working independently assessed the methodological quality and characteristics of included trials and abstracted data on perioperative outcomes (ie, outcomes that occurred during hospitalization or within 30 days of surgery). RESULTS: We identified 34 eligible trials. In the 14 trials that assessed mortality, there were 68 deaths among 2192 patients randomized to insulin infusion compared with 98 deaths among 2163 patients randomized to control therapy (random-effects pooled relative risk, 0.69; 95% confidence interval [CI], 0.51-0.94; 99% CI, 0.46-1.04; I2, 0%; 95% CI, 0.0%-47.4%). Hypoglycemia increased in the intensively treated group (20 trials, 119/1470 patients in insulin infusion vs 48/1476 patients in control group; relative risk, 2.07; 95% CI, 1.29-3.32; 99% CI, 1.09-3.88; I2, 31.5%; 95% CI, 0.0%-59.0%). No significant effect was seen in any other outcomes. The available mortality data represent only 40% of the optimal information size required to reliably detect a plausible treatment effect; potential methodological and reporting biases weaken inferences. CONCLUSION: Perioperative insulin infusion may reduce mortality but increases hypoglycemia in patients who are undergoing surgery; however, mortality results require confirmation in large and rigorous RCTs Udgivelsesdato: 2008/4

Gandhi, G.Y.; Murad, M.H.

2008-01-01

 
 
 
 
81

Optimal intravenous infusion to decrease the haematocrit level in patient of DHF infection  

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The optimal control of infusion model for Dengue Hemorrhagic Fever (DHF) infection is formulated here. The infusion model will be presented in form of haematocrit level. The input control aim to normalize the haematocrit level and is expressed as infusion volume on mL/day. The stability near the equilibrium points will be analyzed. Numerical simulation shows the dynamic of each infection compartments which gives a description of within-host dynamic of dengue virus. These results show particularly that infected compartments tend to be vanished in ±15days after the onset of the virus. In fact, without any control added, the haematocrit level will decrease but not up to the normal level. Therefore the effective haematocrit normalization should be done with the treatment control. Control treatment for a fixed time using a control input can bring haematocrit level to normal range 42-47%. The optimal control in this paper is divided into three cases, i.e. fixed end point, constrained input, and tracking haematocrit state. Each case shows different infection condition in human body. However, all cases require that the haematocrit level to be in normal range in fixed final time.

Handayani, D.; Nuraini, N.; Saragih, R.; Wijaya, K. P.; Naiborhu, J.

2014-02-01

82

Differential insulin responses to oral and intravenous glucose in the transplantable rat insulinoma--a role for GIP.  

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We have previously demonstrated an impaired insulin response to intraperitoneal glucose and arginine by the transplantable NEDH rat insulinoma. The nature of this tumour B-cell defect has been further studied by investigating the response of insulinoma-bearing rats to intravenous and intragastric glucose. Intravenous glucose failed to stimulate plasma immunoreactive insulin (IRI) above high basal levels (14.5 +/- 1.1 micrograms/L). However, significant elevation of the plasma IRI concentration was observed following an intragastric glucose load (17.1 +/- 1.5 micrograms/L; P less than 0.02). In view of the different effects of oral and intravenous glucose on insulin secretion in the RIN, implicating an involvement of incretin factors from the gut, the response of the tumour to GIP was investigated. Plasma IRI concentrations rose significantly in these animals (20.6 +/- 2.5 micrograms/L at 5 min, P less than 0.02). We conclude that (a) the transplantable rat insulinoma is responsive to GIP, and (b) that whilst the tumour B-cell has lost its insulin responsiveness to hyperglycaemia produced by intraperitoneal or intravenous glucose, it retains its ability to respond to intragastric glucose. This could be due to incretin factors from the gut of which GIP is currently the strongest candidate. PMID:3006156

Tan, K S; Kwasowski, P; Marks, V

1986-01-01

83

Effect of intravenous drip infusion of cyclophosphamide with high-dose Astragalus injection in treating lupus nephritis  

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Full Text Available Objective: To observe the effect of high-dose Astragalus injection and cyclophosphamide (CTX on infection, urine protein and immune function of the patients with lupus nephritis.Methods: Forty-three patients diagnosed as systemic lupus erythematosus (SLE complicated by kidney damage and qi-deficiency syndrome were randomly divided into trial group (n=23 and control group (n=20. Patients in both groups were treated for 3 months. Intravenous drip infusion of 0.8 g CTX was administered to all patients once a month, while intravenous drip infusion of 20 ml Astragalus injection was only administered to patients in the trial group every day for 12 days in each month.Results: The decrease of active clinical symptom score after the treatment in the trial group was greater than that in the control group (P<0.05. The infection rates of the trial group and the control group were 4.35% and 25% respectively. The decrease of 24-hour urine protein and CD8, and the increase of red blood cell count and serum albumin in the trial group were greater than those in the control group, and there were significant differences between the two groups (P<0.05. White blood cell count in the trial group was decreased less than that in the control group after the treatment (P<0.05.Conclusion: High-dose Astragalus injection used together with CTX is more effective than CTX alone in decreasing infection rate and urine protein and improving immune function for patients with lupus nephritis.

Li SU

2007-05-01

84

Response of plasma pancreatic and gastrointestinal hormones and growth hormone to oral and intravenous glucose and insulin hypoglycaemia in Chagas's disease.  

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Plasma hormonal responses to insulin hypoglycaemia and to oral and intravenous glucose were investigated in chagasic patients with severe bowel disease and compared with controls matched for age, sex, weight, and race. After intravenous insulin, plasma concentrations of pancreatic glucagon and pancreatic polypeptide (PP) were reduced in the patients with Chagas's disease. These subjects also showed a subnormal rise in plasma insulin after oral glucose. Other hormone responses did not differ s...

Long, R. G.; Albuquerque, R. H.; Prata, A.; Barnes, A. J.; Adrian, T. E.; Christofides, N. D.; Bloom, S. R.

1980-01-01

85

Radiochemical purity, at expiry, and radiochemical stability of iodine-131 labelled meta-iodobenzylguanidine concentrates for intravenous infusion  

International Nuclear Information System (INIS)

The determination of the amount of free [131I]iodide in [131I]metaiodobenzylguanidine ([131I]MIBG) concentrates for intravenous infusion under different storage conditions derived from daily practice. The percentage of free [131I]iodide was determined in [131I]MIBG concentrates (1.6-3.9 GBq in 7.5 ml), kept on dry ice (up to expiry, 3 days after production) or, after thawing, at room temperature (up to 24 h). A validated solid phase extraction (SPE) assay was used. Free [131I]iodide increased from 1.9%±0.34% at production to 4.4%±0.67% (mean±SD; n=5) at expiry in 3.7 GBq per 7.5 ml [131I]MIBG infusion concentrates stored on dry ice (-78 C). At room temperature, formation of free [131I]iodide was found to be dependent on the radioactive concentration of the fluid. [131I]iodide levels increased from 3.1%, immediately after thawing, to 6.6% and 16.6% at t=5 and 24 h, respectively, for a 3.9 GBq per 7.5 ml concentrate. The investigated formulation of [131I]MIBG concentrates, stored in its original packing containing dry ice, can generally be used up to expiry. After thawing, the undiluted concentrates should be administered to a patient within 3.5 h. (orig.)

86

Plasma volume and electrolyte changes following intravenous infusion of hypertonic hydroxyethyl starch versus mannitol in healthy dogs.  

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In a prospective cross-over study, the duration and magnitude of effect on the electrolyte and plasma volume changes of intravenous (IV) hypertonic hydroxyethyl starch (hyperHES) (7.5%/6%) and mannitol (20%) were compared. Eight Beagle dogs received an IV infusion of 4mL/kg hyperHES (group H) and 4mL/kg mannitol 20% (group M) on separate occasions. Urine and blood samples were taken in the first (T(60)) and second (T(120)) hour after infusion. Significant increases in plasma volume at each time point in group H and M were noted when compared to baseline (start of infusion=T(0)) level. There was no significant difference between groups. Both fluids resulted in diuresis, although no significant difference between groups was noted. A significant increase in plasma sodium (Na) was demonstrated in group H between T(0) and T(60) with a significant increase in the Na and chloride (Cl) fractional excretion (FE) between T(0), T(60) and T(120). In group M no changes in plasma electrolyte concentrations were detected, although FE of Na, Cl and K was increased significantly between T(0) and T(60). In conclusion, hyperHES and mannitol appear to have a volume expanding effect lasting at least 120 min. The hypernatraemia induced by hyperHES was minimal compared to previous reports of hypertonic saline use, and no clinical side effects were noted. HyperHES showed comparable effects to mannitol in increasing plasma volume and diuresis and could be considered for these applications. PMID:21112802

Robinson, Rebecca; Schwendenwein, Ilse; Wacek, Sabine; Nell, Barbara; Mosing, Martina

2011-11-01

87

Blood glucose control in healthy subject and patients receiving intravenous glucose infusion or total parenteral nutrition using glucagon-like peptide 1  

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It was the aim of the study to examine whether the insulinotropic gut hormone GLP-1 is able to control or even normalise glycaemia in healthy subjects receiving intravenous glucose infusions and in severely ill patients hyperglycaemic during total parenteral nutrition.

Nauck, Michael A; Walberg, Jörg

2004-01-01

88

Effects of intermittent and long-term glucose-insulin-potassium infusion in patients with systolic heart failure  

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BACKGROUND Although single dose and short-term glucose-insulin-potassium (GIK) infusions are known to have positive cardiac effects, the effects of repeated and long-term GIK infusion on left ventricular (LV) systolic function and brain natriuretic peptide (BNP) levels are unknown. OBJECTIVE To investigate the effects of repeated and long-term GIK infusion on LV systolic function and BNP levels. METHODS Thirty-three patients diagnosed with ischemic cardiomyopathy were included in the study. Patients were divided into two groups: the GIK group (n=19) and the control group (n=14). GIK solutions (1000 mL 20% dextrose, 60 U insulin and 50 mmol/L KCl) were administered at 1 mL/kg/h for 24 h on the first, third and fifth days. The patients were examined by echocardiography at 24 h, one week and one month after the start of treatment. BNP levels were measured before and after GIK infusion. RESULTS In the GIK group, baseline ejection fraction (EF) was 29.2±10.3%. After one week, EF elevated to 40.8±10.8% (P=0.001). The EF after one month (37.1±10.9%) was less than the EF in the first week, but it was significantly higher than baseline in the GIK group (P=0.01). However, no significant changes in EF were observed after one week and one month in the control group (P=0.1 and P=0.2, respectively). BNP levels after GIK infusion was significantly lower than baseline level in the GIK group (P=0.01). CONCLUSION Intermittent and long-term GIK infusion has beneficial effects on LV systolic function in a short and intermediate amount of time. Decrease in BNP levels may indicate effective GIK treatment. Intermittent and long-term GIK infusion could be a promising treatment option in patients with systolic heart failure. PMID:19343122

Kalay, Nihat; Ozdogru, Ibrahim; Gul, Ali; Yucel, Yilmaz; Cetinkaya, Yakup; Inanc, Mehmet Tugrul; Dogan, Ali; Kaya, Mehmet Gungor; Eryol, Namyk Kemal

2008-01-01

89

?-ketoisocaproate (KIC), leucine (LEU), and CO2 metabolism in fed and insulin-infused sheep  

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[1-14C] LEU and [14C] bicarbonate were infused successively into fed sheep. Saline (C) or insulin plus glucose (I) also were infused into a mesenteric vein. Blood samples were taken from portal, hepatic, caudal vena cava and arterial vessels for determination of net and unidirectional metabolism. Arterial insulin concentrations were 26.4 +/- 2.3 in C and 58.5 +/- 6.4 ?U/ml in I but glucagon and glucose concentrations were unchanged. KIC and LEU concentrations decreased in I (9.1 +/- 0.6 to 6.6 +/- 0.3; 89.4 +/- 3.0 to 75.2 +/- 2.6 ?mol/l) whereas CO2 concentrations increased (26.2 +/- 0.6 to 27.2 +/- 0.5 mmol/L). KIC, LEU and CO2 turnovers all decreased in I (13.5 +/- 1.5 to 10.2 +/- 1.0; 132 +/- 11 to 121 +/- 9; 89,900 +/- 780 to 85800 +/- 810 ?mol/min). Whole-body KIC oxidation decreased from 4.1 +/- 0.3 to 3.3 +/- 0.3 but LEU oxidation (8.2 +/- 0.8 ?mol/min) was unchanged. Portal absorption of KIC increased (1.2 +/- 0.3 to 3.1 +/- 0.6) and hepatic utilization was unchanged (2.5 +/- 0.8 ?mol/min). Thus, a splanchnic utilization in C switched to a net production in I. KIC release by the hindquarters decreased from 4.5 +/- 0.9 to 3.0 +/- 0.9 ?mol/min). Net portal production of LEU (7.6 +- 3.3), hepatic utilization (4.1 +/- 1.8) and hindquarters utilization (3.4 +/- 1.0 ?mol/min) were all unchanged in I. Indeed, unidirectional utilization and production of LEU by the hindquarters (5.4 +/- 0.5 to 5.5 +/- 0.7; 4.1 + 0.2 to 4.1 +/- 0.3 ?mol/min) were remarkably consistent

90

Role of alpha 1- and alpha 2-adrenoceptors in catecholamine-induced hyperglycaemia, lipolysis and insulin secretion in conscious fasted rabbits.  

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1. In conscious fasted rabbits an intravenous infusion of clonidine (2 micrograms kg-1 min-1) induced hyperglycaemia. The increase in blood glucose was accompanied by an inhibition of insulin secretion and basal lipolysis. 2. Yohimbine infused at a rate of 20 micrograms kg-1 min-1 suppressed clonidine-induced hyperglycaemia and blocked the inhibitory effect on insulin secretion mediated by the alpha 2-adrenoceptor agonist. 3. The intravenous infusion of amidephrine (10 micrograms kg-1 min-1) ...

Moratinos, J.; Carpene, C.; Pablos, I.; Reverte, M.

1988-01-01

91

Regional myocardial lidocaine concentration following continuous intravenous infusion early and later after myocardial infarction  

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The regional concentration of lidocaine using a double constant infusion technique (250 micrograms/kg/min x 15 minutes followed by 35 micrograms/kg/mg/min x 120 minutes) was studied immediately (2 hours) in seven dogs and 24 hours (six dogs) after myocardial infarction. Tissue levels were determined by gas chromatography and related to regional myocardial blood flow as determined by the radioactive microsphere technique in multiple samples. At 2 hours after infarction a significantly higher lidocaine concentration (4.1 +/- 0.42 micrograms/g) was found in zones with greatly reduced blood flow (regional myocardial blood flow less than 0.2 ml/min per g) when compared with that (2.6 +/- 0.19 micrograms/g) in zones with normal blood flow (regional myocardial blood flow greater than 0.8 ml/min per g) (p less than 0.01). In contrast, in the 24 hour model the opposite situation was observed. Although the concentration of lidocaine in the infarct zone was substantial, a significant decline in lidocaine tissue concentration was found in the zones of lowest blood flow (regional myocardial blood flow less than 0.2 ml/min per g) when compared with that in normal zones (1.76 +/- 0.21 versus 3.38 +/- 0.21 micrograms/g, p less than 0.001). In addition, no significant differences in lidocaine concentrations were found between endocardium and epicardium in any of the groups other than those related to regional myocardial blood flow. Thus, with the double constant infusion technique, lidocaine reached normal and ischemic myocardium in concentrations equivalent to therapeutic plasma concentrations, even in lower infarct blood flow zones, with no significant differences between endocardium and epicardium. Of perhaps greater significance, the age of the ischemic insult is an important determinant of lidocaine tissue distribution in infarcted myocardium

92

First Clinical Experience with a High-Capacity Implantable Infusion Pump for Continuous Intravenous Chemotherapy  

International Nuclear Information System (INIS)

Purpose: To evaluate the efficiency of a new high-capacity pump for systemic venous chemotherapy and to verify the quality of implantation by interventional radiology staff. Methods: A total of 47 infusion pumps with a 60-ml reservoir and variable flow rates (2, 6, 8, or 12 ml/24 hr) were implanted by radiologists in 46 patients with solid tumor metastases requiring treatment with a single, continuously infused cytostatic agent. The reservoir was refilled transcutaneously, usually once weekly. The flow accuracy of the pump was assessed from actual drug delivery recorded on 34 patients over a minimum observation period of 180 days. Results: No early complications occurred in any of the 47 implants in 46 patients. A total of 12 (25.53%) complications occurred between 3 and 24 months after implantation. Seven (14.90%) of these were due to the external design of the pump, while five (10.63%) were related to the central venous catheter. In the 34 patients available for pump evaluation (follow-up of at least 180 days), the system was used for a total of 14,191 days (range 180-911 days, mean 417.38 days), giving an overall complication rate of 0.84 per 1000 days of operation. The mean flow rate accuracy was 90.26%. Conclusion: The new implantable pump showed good flow rate accuracy and reliable operation. The pump-related complications were related to its external design and have now been corrected by appropriate modifications. From a radiologic and surgical viewpoint, the venous implantation procedure is identical to that of conventional vascular access devices and can be performed by radiologists familiar with these techniques. The current limitations lie in the high cost of the pump and, for certain drugs, the short time between refills

93

Fluctuation of adenosine concentration by modes of intravenous infusion based on mathematical simulation and experiments  

International Nuclear Information System (INIS)

e-fold increase in the steady concentration in the vein just after injection. When 0.5 ml of radionuclide was slowly co-injected, with three ways opened, it caused a relatively low fluctuation, creating a +34% to -47% change in concentration of LV. A flush of radionuclide with physiological saline significantly increased the adenosine concentration in LV, when short half-lives were assumed. An intravenous adenosine and radiopharmaceutical injection in the same line is feasible. However, the fluctuation of concentration depends significantly on the mode of injection. To minimize the fluctuation, a slow injection of a small volume of a myocardial imaging agent via a co-injection route, with three ways opened, is recommended. (author)

94

The Various Forms of Insulin Secretion Response to the Intravenous and Oral Administration of Glucose in Non-Insulin-Dependent Diabetes Mellitus  

International Nuclear Information System (INIS)

On the basis of 68 observations on advanced diabetes mellitus (20 cases), latent diabetes with obesity (12 cases), chemical diabetes with subjective symptoms (26 cases) and 10 observations of obesity without diabetes, the authors have analysed the various forms of insulin secretion response to the intravenous and oral administration of glucose. The response appeared to be totally withdrawn in advanced diabetes mellitus although the patients were still capable of responding to stimulation with glucagon. In the two other forms of diabetes described, the response to stimulation by intravenous administration was less marked than in normal subjects. With oral administration, on the other hand, the response was greater, although the insulin secreted in this case appeared ineffective in cases of obesity but effective in conditions without obesity due to the hypoglycaemic effect. (author)

95

For insulin infusion: a miniature precision peristaltic pump and silicone rubber reservoir.  

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This paper describes a miniature precision peristaltic pump and a silicone rubber reservoir developed for the infusion of insulin in diabetic subjects. The ability of the 100-ml reservoir to maintain sterility of its contents over 26 refilling cycles (48 days) is demonstrated. Accelerated bench tests on 10 pumps over 30 days indicate an accuracy of +/- 1% on flow rate whether measured over 10 min or 24 h and with or without 1 atm of outlet back pressure. Comparison of calibrations made before and after 58 animal and clinical tests of 6--71 days' duration showed a percentage difference in calibration that varied with a mean +/- SD of 0.05 +/- 3.09%. Microscopic examination of pump tube samples after 21 days of clinical use indicated redistribution of surface material without evidence of particle spallation. Samples subjected to accelerated wear equivalent to 620 days of clinical use showed extensive luminal surface modification and particulate deposits on downstream filters. These were identified by X-ray spectroscopy as silicon compounds. PMID:6993148

Jackman, W S; Lougheed, W; Marliss, E B; Zinman, B; Albisser, A M

1980-01-01

96

MnDPDP enhancement in rabbit liver after intravenous bolus injection and slow infusion  

International Nuclear Information System (INIS)

Purpose: To investigate the MR-enhancing effect of mangafodipir trisodium (MnDPDP, Teslascan) in the rabbit liver in relation to dose, mode of administration and imaging window. Material and Methods: MnDPDP was administered to 18 rabbits at a dose of 10 ?mol/kg or 20 ?mol/kg, as a bolus injection or infusion. MR imaging of the liver was performed at different time intervals. Results: Peak liver enhancement was typically observed 10-30 min after administration and the enhancement declined with a half-time of about 5 h. This pattern was observed in all sequences (SE 400/15, FLASH, and SE 132/10), with both doses and with both rates of administration. The peak enhancement was greater, though not significantly so after 20 ?mol/kg than after 10 ?mol/kg. A higher relative peak signal was observed with SE 132/10 than with FLASH or SE 400/15. (orig./AJ)

97

Assessment of right ventricular function by intravenous infusion of krypton-81m  

International Nuclear Information System (INIS)

Kr-81m equilibrium ventriculography was used to assess right ventricular (RV) function at rest (R) and during submaximal bicycle exercise (E) in patients (pts) with different cardiopulmonary disorders. Kr-81 was continuously eluted in 5% dextrose from a portable Rb-81 generator and infused through a peripheral vein. Due to the short half-life (13s) and the free diffusibility of Kr-81 through the alveolar membrane, activity in the left side of the heart is negligible. This allows imaging in a RAO position which provides the best separation between the right atrium and the RV. Determination of RV ejection fraction (RVEF) involved the definition of an endiastolic and an endsystolic region of interest by a semiautomatic computer algorithm. The standard deviation of RVEF determinations by two independent observers was 0.047. Kr-81 RVEF was related to X-ray angiographic (XR) RVEF and hemodynamic measurements. The correlation coefficient between Kr-81 and XR RVEF was 0.82(n=25). When all pts were divided into two groups according to their mean pulmonary artery pressure, significant differences in the RVEF during E between these groups were found with both Kr-81 and XR ventriculography. The correspondence between KR-81 and XR data underlines the potential of Kr-81 as a reliable noninvasive tool in assessing RV function

98

Intravenous drip transfusion of recombinant human endostatin combined with arterial infusion chemotherapy for the treatment of advanced carcinomas: a clinical observation  

International Nuclear Information System (INIS)

Objective: To discuss the clinical effects and the safety of intravenous drip transfusion of recombinant human edentate's combined with arterial infusion chemotherapy for the treatment of advanced carcinomas. Methods: Forty-one patients with advanced carcinomas were enrolled in this study. The patients were divided into study group and control group. All patients underwent relevant infusion chemotherapy via the tumor-feeding artery. At the same day when the arterial infusion chemotherapy was completed, patients in study group stated to receive intravenous drip transfusion of recombinant human endostatin, which lasted for 14 days and, then, broke for 7 days (regarded as one therapeutic cycle). No additional treatment was given to the patients in control group. After two therapeutic cycles, the clinical effect was evaluated with RE-CIST criteria and the living quality was assessed with Karnofsky scoring. The adverse effect was compared between two groups. Results: The control rate of disease and the Karnofsky score were significantly higher in study group than thase in control group (P 0.05). Conclusion: For the treatment of advanced carcinomas, intravenous drip transfusion of recombinant human endostatin combined with arterial infusion chemotherapy can markedly improve patient's living quality and disease control rate, besides, this y and disease control rate, besides, this therapy carries few adverse effects. Therefore, it is well worth making the effort to popularize this technique in clinical practice.(authors)

99

Postoperative analgesia in children: a prospective study in intermittent intramuscular injection versus continuous intravenous infusion of morphine.  

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Few advancements in postoperative pain control in children have been made despite longstanding inadequacies in conventional intramuscular analgesic regimens. While overestimating narcotic complication rates, physicians often underestimate efficacious doses, nurses are reluctant to give injections, and many children in pain shy away from shots. This study prospectively focuses on the safety, efficacy, and complication rate of intermittent intramuscular (IM) versus continuous intravenous infusion (IV) of morphine sulfate (MS) in 46 nonventilated children following major chest, abdominal, or orthopedic surgical procedures. Twenty patients assigned to the IM group had a mean age of 6.17 years and a mean weight of 23.0 kg. Twenty-six patients assigned to the IV group had a mean age of 8.74 years and a mean weight of 27.4 kg. The mean IM MS dose was 12.3 micrograms/kg/h while the mean IV dose was 19.8 micrograms/kg/h (P less than .001). Postoperative pain was assessed with a linear analogue scale from 1 to 10 (1, "doesn't hurt"; 10, "worst hurt possible") for 3 days following operation. Using the analysis of covariance (ANACOVA), nurse, parent, and patient mean pain scores in the IV group were significantly lower than those of the IM group when controlled for age, MS dose, and complications (P less than .007). Nurse assessment of pain correlated well with the patient and parent assessments (Pearson correlation coefficients greater than 0.6). Not only did IV infusion give better pain relief than IM injections, but there were no major complications such as respiratory depression. Minor complications in this study (nausea, urinary retention, drowsiness, vomiting, hallucinations, lightheadedness, and prolonged ileus) were not significantly different between IM and IV groups.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2303987

Hendrickson, M; Myre, L; Johnson, D G; Matlak, M E; Black, R E; Sullivan, J J

1990-02-01

100

Effects of intravenous magnesium infusion on in vivo release of acetylcholine and catecholamine in rat adrenal medulla.  

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We applied microdialysis technique to the left adrenal medulla of anesthetized rats and examined the effects of intravenous Mg(2+) infusion on presynaptic acetylcholine (ACh) release and postsynaptic catecholamine release induced by electrical stimulation of splanchnic nerves. The dialysis probes were perfused with Ringer's solution containing neostigmine. Low-dose MgSO4 (25 ?mol/kg/min for 30 min i.v.) increased mean plasma Mg(2+) concentration to 2.5mM; the administration suppressed norepinephrine (NE) release by approximately 30% and epinephrine (Epi) release by approximately 20%, but did not affect ACh release. High-dose MgSO4 (50 ?mol/kg/min for 30 min i.v.) increased mean plasma Mg(2+) concentration to 3.8mM; the administration suppressed ACh release by approximately 25%, NE release by approximately 60% and Epi release by approximately 45%. Administration of Na2SO4 (50 ?mol/kg/min for 30 min i.v.) did not change the release of ACh, NE or Epi. Local administration of nifedipine (200 ?M) suppressed NE release by approximately 40% and Epi release by approximately 30%, but did not affect ACh release. In the presence of nifedipine, low-dose MgSO4 did not suppress the release of ACh, or further suppress NE or Epi compared to nifedipine alone, but high-dose MgSO4 suppressed ACh release by approximately 25% and further suppressed NE release by approximately 60% and Epi release by approximately 50% compared to nifedipine alone. In conclusion, intravenous administration of Mg(2+) inhibits both presynaptic ACh release and postsynaptic catecholamine release in the adrenal medulla, but L-type Ca(2+) channel-controlled catecholamine release may be more sensitive to Mg(2+) than non-L-type Ca(2+) channel-controlled ACh release. PMID:23562142

Komaki, Fumiaki; Akiyama, Tsuyoshi; Yamazaki, Toji; Kitagawa, Hirotoshi; Nosaka, Syuichi; Shirai, Mikiyasu

2013-10-01

 
 
 
 
101

Effect of glucose-insulin-potassium infusion on thallium myocardial clearance  

International Nuclear Information System (INIS)

earance after the saline infusion. Heart rate, aortic and left atrial pressure, sonomicrometer-measured transmural myocardial wall thickness, microsphere-determined myocardial blood flow, and blood glucose and potassium concentrations did not change significantly during GIK or saline infusions. Thus, GIK infusion appears to increase net 201Tl clearance from myocardial zones with and without initial 201Tl loading

102

Effects of continuous intravenous infusion of methoxamine on the intraoperative hemodynamics of elderly patients undergoing total hip arthroplasty.  

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Background Hemodynamic disturbances are common during continuous epidural anesthesia in elderly patients undergoing total hip arthroplasty. This study aimed to investigate the effects of methoxamine on the intraoperative hemodynamics in elderly patients undergoing total hip arthroplasty under epidural anesthesia. Material and Methods This prospective study included 150 elderly patients undergoing elective total hip arthroplasty under epidural anesthesia. Patients were randomly assigned into 5 groups (n=30 per group): a control group receiving saline (Group C), a dopamine group receiving 7 µg/kg/min dopamine (Group D), and methoxamine groups receiving 1, 2, or 3 µg/kg/min methoxamine (Groups M1, M2, and M3, respectively). Hemodynamic parameters were assessed 10 min before anesthesia (T1); 10 min (T2), 20 min, (T3), 30 min (T4), and 60 min (T5) after anesthesia; and at the conclusion of surgery (T6). Results At T2-T6, the mean arterial pressure, central venous pressure, cardiac output, stroke volume, stroke volume ratio, and pulmonary vascular resistance were higher in Groups D, M2, and M3 compared to Group C (pHypertension occurred more frequently in Group M3 than in any other group. Conclusions Continuous intravenous infusion of 2 µg/kg/min methoxamine is safe and effective in maintaining hemodynamic stability in elderly patients undergoing total hip arthroplasty. PMID:25326008

Sun, Defeng; Wu, Yue; Yang, Lin; Han, Jun; Liu, Ruochuan; Wang, Lijie

2014-01-01

103

The release of 35S from the cut hypothalamic end of the pituitary stalk following intravenous infusion of 35S-cysteine in rats  

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The release of radioactive substances from the hypothalamic end of the cut pituitary stalk was determined following intravenous infusion of 35S-cysteine in the rats dehydrated for 3 days. Intravenous injection of 5% sodium chloride, 1% of body weight, resulted in a distinct rise of radioactivity present in the fluid washing the cut infundibulum. In the same animals, the radioactivity of the hypothalamic tissue did not differ from that found in the controls (i.e., in animals simply dehydrated). The implications of these findings are discussed, as compared to the speed of axoplasmic transport in the infundibular axons. (author)

104

Treatment Efficacy of Subcutaneous Insulin Infusion Therapy In Type 1 Diabetic Patients - Orijinal Article  

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Full Text Available Objective: Current goals of treatment of diabetes are to achieve near-normal glycemia, minimize the risk of severe hypoglycemia, limit excessive weight gain, and to improve quality of life. Insulin pump or continuous subcutaneous insulin infusion (CSII therapy provides a treatment option to aid in achieving all of these goals. CSII is a viable alternative to multiple daily injections (MDI therapy for patients with diabetes who are capable and motivated. In this study, we aimed to compare the diabetic control and treatment satisfaction in our patients using CSII and MDI. Materials and Methods: Fifty patients with type 1 diabetes, who had been followed between 2005-2008, were enrolled in the study. Changes in biomedical outcomes (glycated haemoglobin; HbA1c, hypoglycaemia, and weigth gain pre-CSII, during the last year and at the end of the study were analyzed retrospectively. For treatment satisfaction and compliance, we used a questionnaire containing 12 questions. The patients were divided into two groups according to MDI or CSII therapy use for least one year: Group 1 using CSII (n:27 and Group 2 using MDI (n:23. Results: There was no significant difference between the last HbA1c levels in both groups. In CSII group, decrease in HbA1c was 0.79% for average follow-up of 1.66 years ( 9.19%±2.23; 8.40%±1.17. When the two groups were compared in terms of hypoglycemia rates and weight gain over the last year, no statistically significant difference was found, but in CSII group, hypoglycemia rates were lower. Finally, CSII group demonstrated a higher treatment satisfaction rate and higher compliance, while a negative correlation was detected between frequency of home blood glucose monitoring and HbA1c levels in all patients. Conclusion: CSII therapy is effective in improving glycemic control with higher treatment satisfaction when compared with MDI therapy in selected type 1 diabetic patients. Turk Jem 2010; 14: 80-4

Soner

2010-12-01

105

A nationwide study of continuous subcutaneous insulin infusion (CSII) in Denmark.  

DEFF Research Database (Denmark)

AIMS: To record the number of patients treated with continuous subcutaneous insulin infusion (CSII), the attitude to CSII treatment among diabetes care providers and the characteristics of pump users in Denmark. METHODS: A questionnaire was mailed to all departments of endocrinology, internal medicine and paediatrics in Denmark (n = 73) to determine the number of diabetic patients treated with CSII and the attitudes of chief consultants to it. All patients using CSII were identified and data from their records collected. RESULTS: Primarily Type 1 diabetic patients (n = 142) were treated with CSII, approx. 0.5% of patients in Denmark. The explanations given for this low frequency varied for non-CSII and CSII-using diabetologists. Both found lack of funding important. In addition, the non-CSII-using group had a perception that CSII was dangerous. The CSII-using diabetologists found that no more patients were interested and that it did not significantly improve metabolic control. The mean age of pump users was 48.1 +/- 10.5 years and the mean time wearing a pump 14.1 +/- 6.3 years. Mean HbA1c was 7.9 +/- 1.2% during CSII, with a significant difference among the 15 centres (P < 0.05) and a tendency to be lower in females (P = 0.07). CONCLUSIONS: CSII is infrequently used in Denmark despite pump users showing reasonably good metabolic control. The most common explanations for these low figures are lack of expertise and funding for CSII. If more patients in Denmark were to be offered pumps, education of healthcare providers would be needed and the funding would have to be clarified.

NØrgaard, K

2003-01-01

106

The importance of active learning and practice on the students' mastery of pharmacokinetic calculations for the intermittent intravenous infusion dosing of antibiotics  

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Full Text Available Abstract Background Estimation of pharmacokinetic parameters after intermittent intravenous infusion (III of antibiotics, such as aminoglycosides or vancomycin, has traditionally been a difficult subject for students in clinical pharmacology or pharmacokinetic courses. Additionally, samples taken at different intervals during repeated dose therapy require manipulation of sampling times before accurate calculation of the patient-specific pharmacokinetic parameters. The main goal of this study was to evaluate the effectiveness of active learning tools and practice opportunities on the ability of students to estimate pharmacokinetic parameters from the plasma samples obtained at different intervals following intermittent intravenous infusion. Methods An extensive reading note, with examples, and a problem case, based on a patient’s chart data, were created and made available to students before the class session. Students were required to work through the case before attending the class. The class session was devoted to the discussion of the case requiring active participation of the students using a random participation program. After the class, students were given additional opportunities to practice the calculations, using online modules developed by the instructor, before submitting an online assignment. Results The performance of students significantly (P?P? Conclusions Despite being a difficult subject, students achieve mastery of pharmacokinetic calculations for the topic of intermittent intravenous infusion when appropriate active learning strategies and practice opportunities are employed.

Mehvar Reza

2012-11-01

107

Pharmacokinetics of Pamidronate Disodium in Cancer Patients after a Single Intravenous Infusion of 30-, 60- or 90-mg Dose over 4 or 24 Hours.  

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The objective of this study was to determine the pharmacokinetics of pamidronate disodium in plasma and urine after a single intravenous infusion of the drug to cancer patients at risk for developing bone metastases. Thirty-six patients were randomized into six treatment groups to receive 30-, 60- or 90-mg doses of the drug by 4- or 24-h intravenous infusions. Plasma and urine samples were collected at intervals for up to 144 h after drug administration and were assayed for pamidronate disodium using validated reversed-phase HPLC methods. The percentage of the administered dose excreted in urine following a 4- or 24-h infusion of 30-, 60- or 90-mg pamidronate disodium ranged from 30% to 60% except for one individual who excreted 96% by this route of elimination. There was a linear relationship between amount of drug excreted in urine and dose. Curve fitting of ARE (amount of drug to be excreted in urine) data indicated that the disposition kinetics of the drug was consistent with a biexponential process with overall mean plus minus S.D. half-life values of 2.1 plus minus 1.8 and 26.9 plus minus 8.7 h for the alpha and beta phases, respectively. The results of this study showed that the drug exhibited dose proportionality in its pharmacokinetic behavior over the 30--90-mg range regardless of whether it was infused over a 4- or 24-h interval. PMID:11835092

Cheung, W. K.; Brunner, L.; Schoenfeld, S.; Knight, R.; Seaman, J.; Brox, A.; Batist, G.; John, V.; Chan, K.

1994-10-01

108

Sensitization to methyl methacrylate in the plastic catheter of an insulin pump infusion set  

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Cases of allergic contact dermatitis due to acrylics in the adhesive used to attach the needle to the tubing have previously been reported in pump infusion set users, but never previously due to an acrylic in the plastic tubing itself, as in this case. The presence of methyl methacrylate demonstrated in the catheter of the patient’s own infusion set correlated with her positive patch test results. Since patch testing and chemical-physical analysis was negati...

Saccabusi, Stanislao; Boatto, Gianpiero; Asproni, Battistina; Pau, Amedeo

2001-01-01

109

Comparative study of toxic reactions and pharmacological dynamics of DDP administrated by trans-arterial injection and intravenous infusion in patients with NSCLC  

International Nuclear Information System (INIS)

Objective: Through a comparative analysis serum concentration of DDP administrated by intra-arterial injection and intravenous infusion in patients with non-small cell lung cancer (NSCLC), the whole body toxic reactions and the pharmacological mechanism of chemotherapy agents administrated by bronchial artery infusion (BAI) was studied. Methods: In total 60 patients with advanced NSCLC confirmed by pathology were randomly enrolled into two groups in this study. The 30 patients in group A were treated by BAI chemotherapy with DDP at the dose of 80 mg/m2 within 30 min, while MMC at the dose of 10 mg/m2 and VDS at the dose of 3 mg/m2 were given intravenously. Patients in group B was given intravenous chemotherapy of the same components as that given in group A. Blood samples was collected at 5 min, 15 min, 30 min, 1h, 2h, 4h, 8h, 24h and 48h from the beginning of DDP infusion. High performance liquid chromatography (HPLC) was used to measure DDP concentration in blood samples and a time-concentrate curve was drawn. During chemotherapy, the side-effects were investigated. Results: (1) Both group A and B reached a peak concentration at 30 min. Peak concentration value of group B is higher than that of group A. There was a statistical difference of peak concentration between group A and B (P<0.001). (2) AUC value of group B is higher than that of group A, with a statistical difference (P<0.05). (3) The incidence of gastrointestinal complication and kidney function damage has a statistical difference between group A and B (P=0.002 and 0.028 respectively). Conclusion: The side-effects is slighter in BAI chemotherapy than in IV chemotherapy in the treatment of NSCLC

110

Intravenous infusion of dihydroginsenoside Rb1 prevents compressive spinal cord injury and ischemic brain damage through upregulation of VEGF and Bcl-XL.  

Science.gov (United States)

Red ginseng root (Panax Ginseng CA Meyer) has been used clinically by many Asian people for thousands of years without any detrimental effects. One of the major components of Red ginseng root is ginsenoside Rb(1) (gRb1). Previously, we showed that intravenous infusion of gRb1 ameliorated ischemic brain damage through upregulation of an anti-apoptotic factor, Bcl-x(L) and that topical application of gRb1 to burn wound lesion facilitated wound healing through upregulation of vascular endothelial growth factor (VEGF). In the present study, we produced dihydroginsenoside Rb1 (dgRb1), a stable chemical derivative of gRb1, and showed that intravenous infusion of dgRb1 improved spinal cord injury (SCI) as well as ischemic brain damage. As we expected, the effective dose of dgRb1 was ten times lower than that of gRb1. Intravenous infusion of dgRb1 at this effective dose did not affect brain temperature, blood pressure or cerebral blood flow, suggesting that dgRb1 rescued damaged neurons without affecting systemic parameters. In subsequent in vitro studies that focused on dgRb1-induced expression of gene products responsible for neuronal death or survival, we showed that dgRb1 could upregulate the expression of not only Bcl-x(L), but also a potent angiogenic and neurotrophic factor, VEGF. We also showed that dgRb1-induced expression of bcl-x(L) and VEGF mRNA was HRE (hypoxia response element) and STRE (signal transducers and activators of transcription 5 (Stat5) response element) dependent, respectively. PMID:17600519

Sakanaka, Masahiro; Zhu, Pengxiang; Zhang, Bo; Wen, Tong-Chun; Cao, Fang; Ma, Yong-Jie; Samukawa, Keiichi; Mitsuda, Noriaki; Tanaka, Junya; Kuramoto, Makoto; Uno, Hidemitsu; Hata, Ryuji

2007-06-01

111

Changes in the linear attenuation coefficient of canine appendicular bone following intravenous infusion of strontium lactate, measured using gamma-ray computed tomography.  

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Changes in the average linear attenuation coefficient (LAC) within a fixed measurement volume in the proximal end of the dog tibia, which contains trabecular bone and associated soft tissues (the trabecular bone "space"), were monitored continuously using gamma-ray computed tomography (gamma-CT) prior to, during, and following intravenous infusion of strontium (Sr) lactate. An infusion of 1.3-4.7 g of Sr over a period of 110-160 minutes into 20-kg dogs resulted, within 6-8 hours, in an increase of 0.019-0.045 cm-1 (P less than 0.002) in the LAC. Calibration of the gamma-CT system showed that 0.44 mg/cm3 of Sr produced a change of 0.01 cm-1 in the LAC. Using this conversion factor, the Sr concentration in the trabecular bone space resulting from infusion, as measured by flame atomic absorption spectroscopy, agreed with that predicted by the change observed in the LAC. Sr present in the serum and urine was consistent with the changes observed in the LAC over the study period. Control dogs infused with mineral-free solutions showed no change in LAC. Calcium equivalents required to give the changes observed in the LAC using Sr indicate that variations in skeletal turnover in man can be monitored in the peripheral skeleton using gamma-CT. PMID:1571847

Overton, T R; Snyder, R E; Hangartner, T N; Girgis, S; Audette, R J; Secord, D C

1992-04-01

112

The impact of carrier flow rate and infusion set dead-volume on the dynamics of intravenous drug delivery.  

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The dynamics of IV drug delivery resulting from drug infusions connected to main-line crystalloid carriers can be complex and depend on infusion set dead-volume, drug flow rate, and carrier flow rate. While the concept of dead-volume is intuitive, a lack of appreciation of the interaction with the carrier and drug flow rates can lead to unintended clinical effects resulting from large variations in the delivery rate of potent drugs. We derived mathematical models to quantify these interactions. Experimental simulation with methylene blue infusions tested these predictions. The models predict a lag in response time to changes in carrier or drug flow, which is proportional to the dead-volume and inversely related to the total flow rate. Increasing the carrier rate provides an acute drug bolus. Temporary reduction or cessation of carrier flow decreases the rate of drug delivery, potentially for prolonged periods. Furthermore, a drug bolus results from restoration of the carrier flow. The method of connecting an infusion to a carrier and the use history affects the dynamics of drug delivery. Thus, although complex, the impact of infusion set architecture and changes in carrier and drug flow rates are predictable. These quantitative studies may help optimize the safe use of IV drug infusion systems. PMID:15781520

Lovich, Mark A; Doles, Jason; Peterfreund, Robert A

2005-04-01

113

Ghrelin Infusion in Humans Induces Acute Insulin Resistance and Lipolysis Independent of Growth Hormone Signaling  

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OBJECTIVE—Ghrelin is a gut-derived peptide and an endogenous ligand for the growth hormone (GH) secretagogue receptor. Exogenous ghrelin stimulates the release of GH (potently) and adrenocorticotropic hormone (ACTH) (moderately). Ghrelin is also orexigenic, but its impact on substrate metabolism is controversial. We aimed to study direct effects of ghrelin on substrate metabolism and insulin sensitivity in human subjects.

Vestergaard, Esben Thyssen; Gormsen, Lars Christian; Jessen, Niels; Lund, Sten; Hansen, Troels Krarup; Moller, Niels; Jorgensen, Jens Otto Lunde

2008-01-01

114

Continuous intravenous infusion of prostaglandin E1 improves myocardial perfusion reserve in patients with ischemic heart disease assessed by positron emission tomography. A pilot study  

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Recent investigation has demonstrated that prostaglandin E1 (PGE1) therapy increased capillary density in explanted hearts. Dynamic 13N-ammonia positron emission tomography (PET) is reliable for non-invasive measurement of myocardial blood flow and myocardial perfusion reserve (MPR). The aim of this study was to investigate the effects of PGE1 therapy during 4 weeks on reduction of myocardial perfusion abnormalities and increase of MPR in the patients with ischemic heart disease. In this double-blind, placebo-controlled trial, we randomly assigned 11 patients who had symptomatic heart failure and documented myocardial ischemia to 4 weeks intravenous infusion of PGE1 (2.5 ng/kg/min; 8 patients, age 60±13 years) or saline (3 patients, age 57±13 years). Dynamic 13N-ammonia PET scans at rest and during adenosine stress were obtained at baseline and 12 weeks after treatment completion. Quantitative size/severity of perfusion defects and MPR change from baseline to follow-up PET were determined using a 17-segment model. Compared with the control group, baseline MPR in the PGE1 group was significantly lower (1.96±0.78 vs. 2.71±0.73; P1 infusion (1.96±0.78 to 2.16±0.77; P1 infusion sustained MPR improvement in patients with ischemic heart disease. This may be an attractive therapeutic approach for no-option patients with severe ischemic cardiomyopathy. (author)

115

Labetalol infusion for refractory hypertension causing severe hypotension and bradycardia: an issue of patient safety.  

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Incremental doses of intravenous labetalol are safe and effective and, at times, such therapy may need to be augmented by a continuous infusion of labetalol to control severe hypertension. Continuous infusions of labetalol may exceed the recommended maximum daily dose of 300 mg on occasion. We report a case in which hypertension occurring after an abdominal aortic aneurysm repair, initially responsive to intermittent intravenous beta-blockade, became resistant to this therapy leading to the choice of an intravenous labetalol infusion as the therapeutic option. The labetalol infusion resulted in a profound cardiovascular compromise in this postoperative critically ill patient. While infusions of labetalol have successfully been used, prolonged administration in the intensive care unit requires vigilance and the establishment of a therapeutic rationale/policy for interventions, such as the ready availability of glucagon, beta-agonists, phosphodiesterase inhibitors, insulin, and vasopressin when severe cardiovascular depression occurs. PMID:18505576

Fahed, Samir; Grum, Daniel F; Papadimos, Thomas J

2008-01-01

116

Labetalol infusion for refractory hypertension causing severe hypotension and bradycardia: an issue of patient safety  

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Full Text Available Abstract Incremental doses of intravenous labetalol are safe and effective and, at times, such therapy may need to be augmented by a continuous infusion of labetalol to control severe hypertension. Continuous infusions of labetalol may exceed the recommended maximum daily dose of 300 mg on occasion. We report a case in which hypertension occurring after an abdominal aortic aneurysm repair, initially responsive to intermittent intravenous beta-blockade, became resistant to this therapy leading to the choice of an intravenous labetalol infusion as the therapeutic option. The labetalol infusion resulted in a profound cardiovascular compromise in this postoperative critically ill patient. While infusions of labetalol have successfully been used, prolonged administration in the intensive care unit requires vigilance and the establishment of a therapeutic rationale/policy for interventions, such as the ready availability of glucagon, ?-agonists, phosphodiesterase inhibitors, insulin, and vasopressin when severe cardiovascular depression occurs.

Papadimos Thomas J

2008-05-01

117

Evaluation of Meropenem Regimens Suppressing Emergence of Resistance in Acinetobacter baumannii with Human Simulated Exposure in an In Vitro Intravenous-Infusion Hollow-Fiber Infection Model.  

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The emergence of resistance to carbapenems in Pseudomonas aeruginosa can be suppressed by optimizing the administration of meropenem. However, whether the same is true for Acinetobacter baumannii is not fully understood. We assessed the bactericidal activity of meropenem and its potency to suppress the emergence of resistance in A. baumannii with human simulated exposure in an in vitro intravenous-infusion hollow-fiber infection model (HFIM). Two clinical strains of carbapenem-susceptible multidrug-resistant A. baumannii (CS-MDRAB), CSRA24 and CSRA91, were used, and their MICs and mutant prevention concentrations (MPCs) were determined. Six meropenem dosage regimens (0.5, 1.0, or 2.0 g given every 8 h [q8h] with a 0.5-h or 3-h infusion for seven consecutive days) were simulated and then evaluated in the HFIM. Both the total population and resistant subpopulations of the two strains were quantified. Drug concentrations were measured by high-performance liquid chromatography. All dosage regimens, except for the lowest dosage (0.5 g for both the 0.5-h and 3-h infusions), showed 3-log CFU/ml bacterial killing. Dosage regimens of 2.0 g with 0.5-h and 3-h infusions exhibited an obvious bactericidal effect and suppressed resistance. Selective amplification of subpopulations with reduced susceptibility to meropenem was suppressed with a percentage of the dosage interval in which meropenem concentrations exceeded the MPC (T>MPC) of ?20% or with a ratio of T>MPC to the percentage of the dosage interval in which drug concentrations are within the mutant selection window of ?0.25. Our in vitro data support the use of a high dosage of meropenem (2.0 g q8h) for the treatment of severe infection caused by CS-MDRAB. PMID:25182633

Li, Xin; Wang, Lin; Zhang, Xian-Jia; Yang, Yang; Gong, Wei-Tao; Xu, Bin; Zhu, Ying-Qun; Liu, Wei

2014-11-01

118

Effect of dietary nitrogen content and intravenous urea infusion on ruminal and portal-drained visceral extraction of arterial urea in lactating Holstein cows  

DEFF Research Database (Denmark)

Urea extraction across ruminal and portal-drained visceral (PDV) tissues were investigated using 9 rumen-cannulated and multi-catheterized lactating dairy cows adapted to low-N (12.9% crude protein) and high-N (17.1% crude protein) diets in a crossover design. The interaction between adaptation to dietary treatments and blood plasma concentrations of urea was studied by dividing samplings into a 2.5-h period without urea infusion followed by a 2.5-h period with primed continuous intravenous infusion of urea (0.493 ± 0.012 mmol/kg of BW per h). Cows were sampled at 66 ± 14 and 68 ± 12 d in milk and produced 42 ± 1 and 36 ± 1 kg of milk/d with the high-N and low-N diets, respectively. The arterial blood urea concentration before urea infusion was 1.37 and 4.09 ± 0.18 mmol/L with low-N and high-N, respectively. Dietary treatment did not affect the urea infusion-induced increase in arterial urea concentration (1.91 ± 0.13 mmol/L). Arterial urea extraction across the PDV and rumen increased from 2.7 to 5.4 ± 0.5% and from 7.1 to 23.8 ± 2.1% when cows were changed from high-N to low-N, respectively. Urea infusion did not decrease urea extractions, implying that urea transport rates were proportional to arterial urea concentrations. Urea extraction increased more across the rumen wall than across the total PDV for low-N compared with high-N, which implies that a larger proportion of total PDV uptake of arterial urea is directed toward the rumen with decreasing N intake. The ruminal vein - arterial (RA) concentration difference for ammonia increased instantly (first sampling 15 min after initiation of infusion) to the primed intravenous infusion when cows were adapted to the low-N diet. The RA difference for ammonia correlated poorly to the ventral ruminal concentration of ammonia (r = 0.55). Relating the RA difference for ammonia to a function of both ruminal ammonia concentration and the RA difference for urea markedly improved the fit (r = 0.85), indicating that a large fraction of ammonia released to the ruminal veinis absorbed from an epithelial ammonia pool not in equilibrium with the ventral ruminal ammonia pool. Changing cows from high-N to low-N affected the relative blood urea clearance by kidneys and PDV. The clearance by the kidneys decreased from 41 to 27 ± 2 L/h and the clearance by the PDV increased from 52 to 105 ± 12 L/h when the diet was changed from high-N to low-N. In conclusion, urea transport across gut epithelia in cattle is adapting to N status and driven by mass action. Data are commensurable with a model for urea transport across gut epithelia based on regulated expression or activity of facilitative urea transporters.

Kristensen, Niels Bastian; Storm, Adam Christian

2010-01-01

119

Continuous intraperitoneal insulin infusion in type 1 diabetes: a 6-year post-trial follow-up  

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Background Continuous intraperitoneal insulin infusion (CIPII) with an implantable pump is a treatment option for patients with type 1 diabetes mellitus (T1DM). Aim of the present study was to describe the long-term course of glycaemic control, complications, health related quality of life (HRQOL) and treatment satisfaction among T1DM patients treated with CIPII. Methods Nineteen patients that participated in a randomized cross-over trial comparing CIPII and subcutaneous (SC) therapy in 2006 were followed until 2012. Laboratory, continuous glucose monitoring, HRQOL and treatment satisfaction measurements were performed at the start of the study, the end of the SC-, the end of the CIPII treatment phase in 2006 and during CIPII therapy in 2012. Linear mixed models were used to calculate estimated values and to test differences between the moments in time. Results In 2012, more time was spent in hyperglycaemia than after the CIPII treatment phase in 2006: 37% (95% CI 29, 44) vs. 55% (95% CI 48, 63), mean difference 19.8% (95% CI 3.0, 36.6). HbA1c was 65 mmol/mol (95% CI 60, 71) at the end of the SC treatment phase in 2006, 58 mmol/mol (95% CI 53, 64) at the end of the CIPII treatment phase and 65 mmol/mol (95% CI 60, 71) in 2012, respectively (p?>?0.05). In 2012, the median number of grade 2 hypoglycaemic events per week (1 (95% CI 0, 2)) was still significantly lower than during prior SC therapy (3 (95% CI 2, 4)): mean change -1.8 (95% CI -3.4, -0.4). Treatment satisfaction with CIPII was better than with SC insulin therapy and HRQOL remained stable. Pump or catheter dysfunction of the necessitated re-operation in 7 patients. No mortality was reported. Conclusions After 6 years of CIPII treatment, glycaemic regulation is stable and the number of hypoglycaemic events decreased compared to SC insulin therapy. Treatment satisfaction with CIPII is superior to SC insulin therapy, HRQOL is stable and complications are scarce. CIPII is a safe and effective treatment option for selected patients with T1DM, also on longer term. PMID:24708696

2014-01-01

120

Influence of Cytochrome P450 2C19 on the pharmacokinetics of lansoprazole administered by single and successive intravenous infusion in healthy Chinese volunteers  

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Full Text Available This study aimed to explore the effect of CYP2C19 polymorphisms on the pharmacokinetics of lansoprazole administered by single and successive intravenous (iv infusions in healthy Chinese volunteers. A total of 30 subjects, including 20 extensive metabolizers (EMs and 10 poor metabolizers (PMs were recruited and randomly assigned to three groups receiving doses of 15, 30 and 60 mg. All subjects received a single dose of lansoprazole during a 60-min period, and only the 30 mg dose group continued to receive the same dose iv for the next seven days (twice daily. Plasma concentrations of lansoprazole were monitored by high performance liquid chromatography (HPLC at the following times: 15, 30, 45, 60, 75, 105, 165, 225, 300, 390, 480, 600 and 720 min after lansoprazole administration. After a single intravenous infusion in the three groups, AUC, Cmax and t½ were significantly higher in PMs than in EMs, while total clearance (Cltotal in PMs was significantly lower than that in EMs. Mean AUC and Cmax ratios in EMs and PMs were 2.1:1 and 1.4:1, respectively. After repeated doses of 30 mg, the AUC, Cmax, and t½ increased significantly, while the Cltotal decreased significantly in EMs. Mean AUC and Cmax ratios in EMs and PMs amounted to 2.2:1.4 and 1.5:1.2, respectively. Lansoprazole displays a linear increase in AUC and Cmax over a dose range of 15-60 mg, and these were dependent on individual CYP2C19 status.

Xiyong Zhang

2012-01-01

 
 
 
 
121

Normal neurologic and developmental outcome after an accidental intravenous infusion of expressed breast milk in a neonate.  

LENUS (Irish Health Repository)

Here we describe a premature male infant who was accidentally given 10 mL of expressed breast milk intravenously over a 3.5-hour period. Having survived this event with supportive care, this boy was attending regular school with no obvious neurologic or learning difficulties at 6 years of age. In 1998, after a query on an e-mail discussion group for health care providers in neonatology (NICU-net), we were informed of 8 similar events that proved fatal in 3 infants. A root-cause analysis revealed that accidental intravenous administration of breast milk or formula can be avoided by the use of color-coded enteral-administration sets with Luer connections that are not compatible with intravenous cannulas. The addition of methylene blue to feeds, or bolus enteral feeds (instead of continuous gastric feedings), may also help prevent such errors. These cases show the value of gathering information about rare but important events through a neonatal network. In addition, they confirm that prevention of medical error should focus on faulty systems rather than faulty people.

Ryan, C Anthony

2012-02-03

122

End-of-dose akinesia after a single intravenous infusion of the dopaminergic agonist piribedil in Parkinson's disease patients: a pharmacokinetic/pharmacodynamic, randomized, double-blind study.  

Science.gov (United States)

This randomized, double-blind trial was designed to define the possible relationship between piribedil plasma concentrations and the decrease of the Unified Parkinson's Disease Rating Scale (UPDRS) motor score or the switch from off to on state after single intravenous infusion. Ten fluctuating patients with idiopathic Parkinson's disease (PD) received escalating doses of piribedil (2-16 mg) and placebo. Starting from 2 mg, piribedil was effective in reducing the motor deficit (UPDRS, motor score) including akinesia at the first evaluation time point of 15 minutes, and in reversing off state of 7 of 10 patients. The doses were equally effective, although the effect was more sustained with the highest dose of 16 mg. Piribedil was well tolerated up to a 16-mg dose and pharmacokinetics were linear up to the 16-mg dose. Plasma levels of piribedil were not correlated to the motor score improvement or switch from off-->on. In conclusion, a short single infusion of piribedil at 2 to 16 mg was safe and effective in improving motor symptoms, including akinesia, of fluctuating PD patients. PMID:15726579

Simon, Nicolas; Micallef, Joëlle; Reynier, Jean-Charles; Lesourd, Monique; Witjas, Tatiana; Alicherif, André; Azulay, Jean-Philippe; Blin, Olivier

2005-07-01

123

Increased Nitrogen Retention after Trans-Operative Intravenous Amino Acid and Glucose Infusion, without Changes in Urinary Amino Acid, Adrenaline and Plasma Urea or Glucose  

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Full Text Available Objective: Nutritional deficiencies are associated with increased morbidity and mortality during and after surgery. The present study evaluated nitrogen retention after transoperative intravenous infusion of amino acids and glucose. Design: Prospective study. Setting: Large community hospital. Patients: 18 randomly chosen patients undergoing medium or major surgeries. Interventions and Measurements: The experimental design included a 12-hour period before surgery (P1, a trans-operative period of 6 hours (P2, an early postoperative period (P3, 18 hours, and a late postoperative period (P4, 24 hours. Urinary amino acid and nitrogen were analyzed from P1 through P4. Group I, nine patients, received Ringer’s lactate solution with 5% glucose, and Group II, another nine patients, received a 6.6% amino acid and 16.6% glucose solution over a 6-hour trans-operative period (P2 starting from the anesthesia procedures. All surgical procedures lasted a maximum of 3 hours. Results: There was no statistically significant difference in urinary amino acid or adrenaline excretion between P1 and P4 in either group. Nitrogen excretion values were also similar for both groups, i.e., 0.39 ± 0.16 and 0.39 ± 0.28 g/hour, respectively. The nitrogen balance showed greater nitrogen retention (?0.25 ± 0.24 g/hour in the group receiving the amino acid infusion compared to the group receiving Ringer’s lactate solution (?0.59 ± 0.26 g/hour (P < 0.05. Blood plasma urea nitrogen and glycaemia did not increase at the end of the study (P4 period in either group. Conclusion: These data indicate that trans-operative infusion of glucose and amino acids can be beneficial for patients submitted to surgical stress in terms of nitrogen retention.

Ernann Tenorio Albuquerque-Filho

2014-04-01

124

The blood-retinal barrier permeability to fluorescein in juvenile diabetics treated with continuous subcutaneous insulin infusion  

DEFF Research Database (Denmark)

To determine possible quantitative changes of the blood-retinal barrier permeability in juvenile diabetics treated with continuous subcutaneous insulin infusion (CSII), we studied seven patients (three females and four males, mean age 36 years) with a mean duration of the disease of 19 years. The pump treatment was continued for seven to eight days and during the treatment mean blood glucose level decreased to near-normal values (before 13.7 mmol per liter - during 6.2 mmol per liter). There was no changes in retinal appearance during treatment. Determination of the blood-retinal barrier permeability showed no quantitative changes during the one week treatment with CSII (mean permeability before 7.6 10 divided by 7 cm/sec - mean permeability during 7.8 10 divided by 7 cm/sec). In order to quantitate possible long-term reversibility of break-down of the blood-retinal barrier we have design to extend the treatment period.

Krogsaa, B; Lund-Andersen, H

1985-01-01

125

Efeitos da infusão contínua de propofol ou etomidato sobre variáveis intracranianas em cães Effects of propofol or etomidate intravenous infusion on intracranial variables in dogs  

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Full Text Available Avaliaram-se os efeitos da infusão contínua de propofol ou de etomidato sobre as variáveis intracranianas em cães nomocapneicos. Foram utilizados 20 cães adultos distribuídos aleatoriamente em dois grupos: grupo propofol (GP e grupo etomidato (GE. Para o GP, os animais foram induzidos à anestesia com propofol (10mg/kg e, ato contínuo, iniciaram-se a infusão do fármaco (0,6mg/kg/min e a ventilação controlada. No GE, o etomidato foi usado para indução (5mg/kg e manutenção empregando-se a dose de 0,5mg/kg/min nos 10 minutos iniciais e, em seguida, de 0,2mg/kg/min. Após 30 minutos da implantação do cateter de fibra óptica do monitor de pressão intracraniana (PIC na superfície do córtex cerebral direito, realizaram-se as primeiras mensurações (M1 da PIC, da pressão de perfusão cerebral (PPC, da temperatura intracraniana (TIC, de temperatura corpórea (TC, da pressão arterial média (PAM e da frequência cardíaca (FC. As demais mensurações ocorreram em intervalos de 20 minutos (M2, M3 e M4. O propofol e o etomidato não ocasionaram alterações significativas nas variáveis estudadas com exceção da TC e TIC. Concluiu-se que a infusão contínua desses fármacos em cães mantém a perfusão cerebral e a autorregulação cerebral. Cães anestesiados com etomidato apresentam efeitos adversos intensos e redução gradativa da temperatura corpórea e intracraniana.The effects of total intravenous infusion of propofol or etomidate on intracranial variables in normocapneic dogs were evaluated. Twenty adult mongrel dogs were randomly allotted to: propofol group (GP or etomidate group (GE. In GP animals, the propofol was used for induction (10mg/kg, followed by immediate continuous infusion of the drug (0.6mg/kg/min and controlled ventilation. In GE dogs, the etomidate was used for induction (5mg/kg, followed by a continuous rate infusion (CRI at 0.5mg/kg/min during the first ten minutes and, right after, it was changed to 0.2mg/kg/min. The initial measurement (M1 was recorded 30 minutes after the implant of the fiber optic catheter and, after that, every 20 minutes (M2, M3, and M4. The studied parameters were intracranial pressure (ICP, cerebral perfusion pressure (CPP, intracranial temperature (ICT, body temperature (BT, mean arterial pressure (MAP, and heart rate (HR. The propofol and etomidate did not change the studied variables, except the ICT and BT. It was concluded that the continuous infusion of these drugs maintains the cerebral perfusion and autoregulation. Dogs anesthetized with etomidate have adverse effects and body and intracranial temperature decrease.

D.P. Paula

2010-04-01

126

Symptomatic cerebral oedema during treatment of diabetic ketoacidosis: effect of adjuvant octreotide infusion  

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Abstract Introduction A potentially lethal complication of diabetic ketoacidosis (DKA) in children is brain oedema, whether caused by DKA itself or by the therapeutic infusion of insulin and fluids. Case presentation A 10-year old previously healthy boy with DKA became unconscious and apnoeic due to cerebral oedema (confirmed by abnormal EEG and CT-scan) during treatment with intravenous fluids (36 ml/h) and insulin (0.1 units/kg/h). He was intubated and artific...

2010-01-01

127

Eventos adversos en 1395 infusiones con diferentes preparados de gammaglobulina intravenosa / Adverse events in 1395 infusions with different intravenous gammaglobulin products  

Scientific Electronic Library Online (English)

Full Text Available SciELO Argentina | Language: Spanish Abstract in spanish Los procesos de aislamiento y esterilización de la gammaglobulina endovenosa (IVIG) afectan las características del producto terminado y, por lo tanto, su tolerabilidad. Distintos productos tienen diferentes incidencias de reacciones adversas. Este trabajo cuantifica los eventos adversos (EA) inmedi [...] atos provocados por distintas preparaciones de IVIG. Analizamos 1395 infusiones en 28 pacientes, con una mediana de 32.5 por sujeto (rango 2-214), utilizando seis preparados distintos de IVIG, con una dosis total promedio de 40.3 ± 8.3 g. Analizamos retrospectivamente 1 031 infusiones y 364 prospectivamente. Los pacientes utilizaron una media de 2.68 ± 1.8 IVIG diferentes, con una mediana de 2 (rango 1-6) por persona. El número de marcas comerciales utilizadas se relacionó con el número de infusiones recibidas, r = 0.73. En 24 (2.3%) de 1031 infusiones analizadas en forma retrospectiva se registraron EA que afectaron a 11 de los 23 casos incluidos, con una media de 2.18 ± 1.08 EA por afectado. De 24 pacientes y de 364 infusiones prospectivas, en 14 pacientes y en 32 (7.2%) procedimientos se observaron EA. Veinticuatro (42.9%) de 56 EA fueron leves, 31 (55.5%) moderados y uno (1.8%) fue grave. La velocidad de infusión fue de 9.04 ± 4.6 g/h para las que presentaron EA vs. 10.6 ± 4.6 g/h para las que no (p = 0.31). La incidencia, la gravedad y la proporción de pacientes afectados con EA para cada marca comercial de IVIG fueron muy diferentes entre sí. Esta información debe ser tomada en cuenta en el momento de selección de la IVIG a utilizar. Abstract in english The processes of isolation and sterilization of intravenous gamma globulin (IVIG) affect the end product characteristics and, therefore, its tolerability. Different products have different incidences of adverse reactions. The aim of this study was to quantify the immediate adverse events (AE) caused [...] by the different IVIG preparations. We analyzed 1 395 infusions in 28 patients, with a median of 32.5 per subject (range 2-214), using six different IVIG preparations, with an average dose 40.3 ±8.3 g. One thousand and thirty-one infusions were analyzed retrospectively and 364 prospectively. Patients used a mean of 2.68 ±1.8 different IVIGs, with a median of 2 (range 1-6) per person. The number of trademarks used was related to the number of infusions received, r = 0.73. AE presented in 24 (2.3%) of 1 031 infusions retrospectively analyzed, affecting 11 of 23 patients enrolled, with a mean of 2.18 ± 1.08 AE per subject. Of 24 patients and 364 infusions prospectively analyzed, AE were observed in 14 patients and in 32 (7.2%) procedures. Twenty-four (42.9%) of 56 AE were mild, 31 (55.5%) moderate and one (1.8%) severe. The infusion rate was 9.04±4.6 g/h for those presenting AE vs. 10.6±4.6 g/h for those who did not (p = 0.31, NS). The incidence, severity and proportion of patients with AE for each brand of IVIG were very different from each other. This information should be taken into account when selecting the IVIG to be used.

Alejandro, Malbrán; Blas, Larrauri; María Cecilia, Juri; Diego S., Fernández Romero.

2013-10-01

128

Eventos adversos en 1395 infusiones con diferentes preparados de gammaglobulina intravenosa / Adverse events in 1395 infusions with different intravenous gammaglobulin products  

Scientific Electronic Library Online (English)

Full Text Available SciELO Argentina | Language: Spanish Abstract in spanish Los procesos de aislamiento y esterilización de la gammaglobulina endovenosa (IVIG) afectan las características del producto terminado y, por lo tanto, su tolerabilidad. Distintos productos tienen diferentes incidencias de reacciones adversas. Este trabajo cuantifica los eventos adversos (EA) inmedi [...] atos provocados por distintas preparaciones de IVIG. Analizamos 1395 infusiones en 28 pacientes, con una mediana de 32.5 por sujeto (rango 2-214), utilizando seis preparados distintos de IVIG, con una dosis total promedio de 40.3 ± 8.3 g. Analizamos retrospectivamente 1 031 infusiones y 364 prospectivamente. Los pacientes utilizaron una media de 2.68 ± 1.8 IVIG diferentes, con una mediana de 2 (rango 1-6) por persona. El número de marcas comerciales utilizadas se relacionó con el número de infusiones recibidas, r = 0.73. En 24 (2.3%) de 1031 infusiones analizadas en forma retrospectiva se registraron EA que afectaron a 11 de los 23 casos incluidos, con una media de 2.18 ± 1.08 EA por afectado. De 24 pacientes y de 364 infusiones prospectivas, en 14 pacientes y en 32 (7.2%) procedimientos se observaron EA. Veinticuatro (42.9%) de 56 EA fueron leves, 31 (55.5%) moderados y uno (1.8%) fue grave. La velocidad de infusión fue de 9.04 ± 4.6 g/h para las que presentaron EA vs. 10.6 ± 4.6 g/h para las que no (p = 0.31). La incidencia, la gravedad y la proporción de pacientes afectados con EA para cada marca comercial de IVIG fueron muy diferentes entre sí. Esta información debe ser tomada en cuenta en el momento de selección de la IVIG a utilizar. Abstract in english The processes of isolation and sterilization of intravenous gamma globulin (IVIG) affect the end product characteristics and, therefore, its tolerability. Different products have different incidences of adverse reactions. The aim of this study was to quantify the immediate adverse events (AE) caused [...] by the different IVIG preparations. We analyzed 1 395 infusions in 28 patients, with a median of 32.5 per subject (range 2-214), using six different IVIG preparations, with an average dose 40.3 ±8.3 g. One thousand and thirty-one infusions were analyzed retrospectively and 364 prospectively. Patients used a mean of 2.68 ±1.8 different IVIGs, with a median of 2 (range 1-6) per person. The number of trademarks used was related to the number of infusions received, r = 0.73. AE presented in 24 (2.3%) of 1 031 infusions retrospectively analyzed, affecting 11 of 23 patients enrolled, with a mean of 2.18 ± 1.08 AE per subject. Of 24 patients and 364 infusions prospectively analyzed, AE were observed in 14 patients and in 32 (7.2%) procedures. Twenty-four (42.9%) of 56 AE were mild, 31 (55.5%) moderate and one (1.8%) severe. The infusion rate was 9.04±4.6 g/h for those presenting AE vs. 10.6±4.6 g/h for those who did not (p = 0.31, NS). The incidence, severity and proportion of patients with AE for each brand of IVIG were very different from each other. This information should be taken into account when selecting the IVIG to be used.

Alejandro, Malbrán; Blas, Larrauri; María Cecilia, Juri; Diego S., Fernández Romero.

129

Insulin responses to acute glucose infusions in Buša and Holstein-Friesian cattle breed during the peripartum period: Comparative study  

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Full Text Available The aim of this study was to compare insulin responsevness to acute glucose infusion in cows of Holstein Friesian (HF and Buša breeds during the peripartal period. Eight cows per each group (HF and Buša, were chosen. At day 7 prior to calving (ante partum and day 14 after calving (post partum animals were subjected to a glucose tolerance test (GTT. Blood samples were taken immediately before infusion and 15, 30, 60, 120 and 180 min thereafter. Glucose and insulin concentrations were measured in each blood sample, while BHBA and NEFA were measured only in samples taken before the infusion. QUICKY an indicator of insulin resistance in cows was calculated. Basal glycemia did not significantly differ between the breeds. Basal insulinemia was significantly higher in Buša than in HF cows in both examined periods (p<0.001, respectively. Basal NEFA levels tended (p=0.06 to be higher in Buša cows compared with those of HF ante partum, and was significantly higher (p<0.001 post partum. Basal BHBA was significantly lower in Buša than HF cows in both examined periods (p<0.01; p<0.001. QUICKI was significantly lower in Buša compared to HF cows both ante partum and post partum periods (p<0.001, respectively. Glycemia determined during GTT were higher in Buša than HF cows, both ante partum and post partum, but significantly starting from minute 15 ante partum i.e. minute 30 post partum. Insulinemia determined during GTT was significantly lower at min 15, and significantly higher starting from min 90 in Buša than HF cows, both ante partum and post partum. Results obtained in this study indicate on difference in insulin responsevness to acute glucose infusion between the examined breeds, which is probably a consequence of the difference in the degree of negative energy balance rather than of selection on high milk production. Namely, decreased insulin tissues sensitivity and decreased insulin responsiveness in Buša compared to HF cows is probably the consequence of inadequate energy intake from alimentary sources which leads to enhanced usage of energy from body reserves. [Projekat Ministarstva nauke Republike Srbije, br. 46002

Prodanovi? R.

2013-01-01

130

Insulin  

Science.gov (United States)

... closed like a laundry detergent bottle. Check the expiration date on the insulin before you use it. Make ... insulin needles (syringes), pens, and injectors after the expiration date printed on the label or on the box. ...

131

Studies on Several Hormone Responses Following Intravenous Alimentation: Insulin and growth hormone responses following oral or intravenous alimentation in patient with far advanced gastric cancer  

International Nuclear Information System (INIS)

Glucose tolerance, insulin and growth hormone responses following glucose for amino acids administration by means of parenteral or oral load were studied in patients with far advanced gastric cancer. Hormone responses following nutrients load showed in patients with gastric cancer were compared to those of healthy subjects. Results were as follows:1) Blood sugar appearance following oral glucose administration was diminished in patients with far advanced gastric cancer. 2) The insulin responses of gastric cancer following oral glucose were also diminished as compared to that of normal subjects and were identical with parenteral route. 3) Parenteral administration of glucose or amino acids to patients with gastric cancer resulted in a increase of plasma growth hormone level. 4) Lower insulin response to amino acids was observed on parenteral administration in patient with gastric cancer as in healthy subjects. 5) Author discussed that the low insulin response after oral glucose administration showed in gastric cancer, and any additional insulin requirement arise when longer periods of parenteral amino acid administration are necessary, as in the patient with malnutrition.

132

Studies on Several Hormone Responses Following Intravenous Alimentation: Insulin and growth hormone responses following oral or intravenous alimentation in patient with far advanced gastric cancer  

Energy Technology Data Exchange (ETDEWEB)

Glucose tolerance, insulin and growth hormone responses following glucose for amino acids administration by means of parenteral or oral load were studied in patients with far advanced gastric cancer. Hormone responses following nutrients load showed in patients with gastric cancer were compared to those of healthy subjects. Results were as follows:1) Blood sugar appearance following oral glucose administration was diminished in patients with far advanced gastric cancer. 2) The insulin responses of gastric cancer following oral glucose were also diminished as compared to that of normal subjects and were identical with parenteral route. 3) Parenteral administration of glucose or amino acids to patients with gastric cancer resulted in a increase of plasma growth hormone level. 4) Lower insulin response to amino acids was observed on parenteral administration in patient with gastric cancer as in healthy subjects. 5) Author discussed that the low insulin response after oral glucose administration showed in gastric cancer, and any additional insulin requirement arise when longer periods of parenteral amino acid administration are necessary, as in the patient with malnutrition.

Sung, H. K.; Koh, J. H.; Ryu, Y. W.; Lee, J. O.; Lee, C. W.; Kim, J. Y.; Lee, J. K. [Korea Atomic Energy Research Institute, Seoul (Korea, Republic of)

1975-09-15

133

Completa recuperación de grave síndrome de hueso hambriento usando infusión crónica ambulatoria de calcio intravenoso: Caso clínico Complete recovery of life-threatening hungry bone syndrome using long-term ambulatory intravenous calcium infusion: Report of one case  

Directory of Open Access Journals (Sweden)

Full Text Available We report a 29 years old woman with a highly symptomatic primary hyperparathyroidism. After parathyroid adenoma excision, she presented a prolonged and life threatening hypocalcemia, due to a severe hungry bone syndrome. Conventional treatment with oral and intravenous calcium and calcitriol supplementation failed to raise serum and urinary calcium or to relief symptoms. After one month, we indicated a continuous intravenous calcium infusion allowing, during 6 months, an adequate outpatient management. Initial T scores for bone density were markedly low (L2-L4: -3.14; femoral neck: -3.07 and they increased 17% after 18 days of calcium infusion. After 147 days of treatment bone density was normal, increasing by 61%. The present case shows that the hungry bone syndrome can be a real risk for patients and a complex therapeutic challenge. With an appropriate calcium supply an early, fast and complete recovery of bone mass can be achieved (Rev Méd Chile 2003; 131: 779-84

Claudia Campusano M

2003-07-01

134

Efeitos da infusão contínua de propofol ou etomidato sobre variáveis intracranianas em cães / Effects of propofol or etomidate intravenous infusion on intracranial variables in dogs  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese Avaliaram-se os efeitos da infusão contínua de propofol ou de etomidato sobre as variáveis intracranianas em cães nomocapneicos. Foram utilizados 20 cães adultos distribuídos aleatoriamente em dois grupos: grupo propofol (GP) e grupo etomidato (GE). Para o GP, os animais foram induzidos à anestesia [...] com propofol (10mg/kg) e, ato contínuo, iniciaram-se a infusão do fármaco (0,6mg/kg/min) e a ventilação controlada. No GE, o etomidato foi usado para indução (5mg/kg) e manutenção empregando-se a dose de 0,5mg/kg/min nos 10 minutos iniciais e, em seguida, de 0,2mg/kg/min. Após 30 minutos da implantação do cateter de fibra óptica do monitor de pressão intracraniana (PIC) na superfície do córtex cerebral direito, realizaram-se as primeiras mensurações (M1) da PIC, da pressão de perfusão cerebral (PPC), da temperatura intracraniana (TIC), de temperatura corpórea (TC), da pressão arterial média (PAM) e da frequência cardíaca (FC). As demais mensurações ocorreram em intervalos de 20 minutos (M2, M3 e M4). O propofol e o etomidato não ocasionaram alterações significativas nas variáveis estudadas com exceção da TC e TIC. Concluiu-se que a infusão contínua desses fármacos em cães mantém a perfusão cerebral e a autorregulação cerebral. Cães anestesiados com etomidato apresentam efeitos adversos intensos e redução gradativa da temperatura corpórea e intracraniana. Abstract in english The effects of total intravenous infusion of propofol or etomidate on intracranial variables in normocapneic dogs were evaluated. Twenty adult mongrel dogs were randomly allotted to: propofol group (GP) or etomidate group (GE). In GP animals, the propofol was used for induction (10mg/kg), followed b [...] y immediate continuous infusion of the drug (0.6mg/kg/min) and controlled ventilation. In GE dogs, the etomidate was used for induction (5mg/kg), followed by a continuous rate infusion (CRI) at 0.5mg/kg/min during the first ten minutes and, right after, it was changed to 0.2mg/kg/min. The initial measurement (M1) was recorded 30 minutes after the implant of the fiber optic catheter and, after that, every 20 minutes (M2, M3, and M4). The studied parameters were intracranial pressure (ICP), cerebral perfusion pressure (CPP), intracranial temperature (ICT), body temperature (BT), mean arterial pressure (MAP), and heart rate (HR). The propofol and etomidate did not change the studied variables, except the ICT and BT. It was concluded that the continuous infusion of these drugs maintains the cerebral perfusion and autoregulation. Dogs anesthetized with etomidate have adverse effects and body and intracranial temperature decrease.

D.P., Paula; N., Nunes; C.T.D., Nishimori; P.C.F., Lopes; R., Carareto; P.S.P., Santos.

2010-04-01

135

Efeitos da infusão contínua de propofol ou etomidato sobre variáveis intracranianas em cães / Effects of propofol or etomidate intravenous infusion on intracranial variables in dogs  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese Avaliaram-se os efeitos da infusão contínua de propofol ou de etomidato sobre as variáveis intracranianas em cães nomocapneicos. Foram utilizados 20 cães adultos distribuídos aleatoriamente em dois grupos: grupo propofol (GP) e grupo etomidato (GE). Para o GP, os animais foram induzidos à anestesia [...] com propofol (10mg/kg) e, ato contínuo, iniciaram-se a infusão do fármaco (0,6mg/kg/min) e a ventilação controlada. No GE, o etomidato foi usado para indução (5mg/kg) e manutenção empregando-se a dose de 0,5mg/kg/min nos 10 minutos iniciais e, em seguida, de 0,2mg/kg/min. Após 30 minutos da implantação do cateter de fibra óptica do monitor de pressão intracraniana (PIC) na superfície do córtex cerebral direito, realizaram-se as primeiras mensurações (M1) da PIC, da pressão de perfusão cerebral (PPC), da temperatura intracraniana (TIC), de temperatura corpórea (TC), da pressão arterial média (PAM) e da frequência cardíaca (FC). As demais mensurações ocorreram em intervalos de 20 minutos (M2, M3 e M4). O propofol e o etomidato não ocasionaram alterações significativas nas variáveis estudadas com exceção da TC e TIC. Concluiu-se que a infusão contínua desses fármacos em cães mantém a perfusão cerebral e a autorregulação cerebral. Cães anestesiados com etomidato apresentam efeitos adversos intensos e redução gradativa da temperatura corpórea e intracraniana. Abstract in english The effects of total intravenous infusion of propofol or etomidate on intracranial variables in normocapneic dogs were evaluated. Twenty adult mongrel dogs were randomly allotted to: propofol group (GP) or etomidate group (GE). In GP animals, the propofol was used for induction (10mg/kg), followed b [...] y immediate continuous infusion of the drug (0.6mg/kg/min) and controlled ventilation. In GE dogs, the etomidate was used for induction (5mg/kg), followed by a continuous rate infusion (CRI) at 0.5mg/kg/min during the first ten minutes and, right after, it was changed to 0.2mg/kg/min. The initial measurement (M1) was recorded 30 minutes after the implant of the fiber optic catheter and, after that, every 20 minutes (M2, M3, and M4). The studied parameters were intracranial pressure (ICP), cerebral perfusion pressure (CPP), intracranial temperature (ICT), body temperature (BT), mean arterial pressure (MAP), and heart rate (HR). The propofol and etomidate did not change the studied variables, except the ICT and BT. It was concluded that the continuous infusion of these drugs maintains the cerebral perfusion and autoregulation. Dogs anesthetized with etomidate have adverse effects and body and intracranial temperature decrease.

D.P., Paula; N., Nunes; C.T.D., Nishimori; P.C.F., Lopes; R., Carareto; P.S.P., Santos.

136

Basal–Prandial Insulin Delivery in Type 2 Diabetes Mellitus via the V-Go™: A Novel Continuous Subcutaneous Infusion Device  

Science.gov (United States)

Background The V-Go™ is a once-daily disposable device that allows coverage of basal and prandial insulin requirements over a period of 24 hours. The aim of this proof-of-concept study was to evaluate the clinical functionality, safety, and pharmacodynamics of the V-Go delivering insulin aspart and redistributing a single basal dose of insulin glargine as a constant basal infusion supplemented with prandial insulin in subjects with type 2 diabetes mellitus. Methods In six subjects receiving once-daily subcutaneous (SC) injections of insulin glargine (?15 U/day) with or without concomitant oral antidiabetic drugs, glargine was discontinued following a 3-day baseline phase. The V-Go was then applied to the lower abdomen of the subjects once daily for 7 days (days 1–3 inpatient, days 4–7 outpatient). Each V-Go provided a continuous 24-hour preset basal infusion rate of insulin aspart (0.6 U/h) and up to three daily prandial doses at mealtimes. Capillary blood glucose concentrations were measured at 11 time points per day during the baseline and inpatient phases and at 4 time points per day during the outpatient phase. Additionally, glucose profiles were measured continuously on all days. Results The V-Go was well tolerated and operated as anticipated. The mean ± SEM prestudy daily dose of SC insulin glargine was 33.3 ± 13.8 U; the mean daily total insulin aspart dose infused with the V-Go was 31.5 ± 7.5 and 32.3 ± 7.8 U for the inpatient and outpatient periods, respectively. Fasting blood glucose values were similar to those observed at baseline throughout the study, with nonsignificant (NS) reductions in readings collected during the outpatient phase before lunch (-35 ± 27 mg/dl) and before dinner (-38 ± 25 mg/dl). The 2-hour postprandial glucose trended lower from 231 to 195 mg/dl (NS) at breakfast, 234 to 166 mg/dl (NS) at lunch, and 222 to 171 mg/dl (NS) at dinner. Bedtime blood glucose decreased (mean change from baseline -52 ± 21 mg/dl; P = 0.0313), as did nighttime (3:00 AM) measurements (-20 ± 9 mg/dl; P = 0.0313). Overall glycemic control tended to improve, as shown by continuous glucose monitoring changing from 173 to 157 mg/dl (P = 0.063, NS) and 156 mg/dl (P = 0.219) during inpatient and outpatient periods, respectively. Glycemic variability assessed by the M value similarly tended to decrease from 33 ± 9 to 25 ± 4 (NS) and 21 ± 4 (NS) for inpatient and outpatient periods, respectively. Conclusions These first data suggest that use of the V-Go is an attractive alternative to SC insulin injection therapy because metabolic control appears to be maintained or even improved without increasing daily insulin doses. PMID:19885176

Kapitza, Christoph; Fein, Seymour; Heinemann, Lutz; Schleusener, Debra; Levesque, Steven; Strange, Poul

2008-01-01

137

Massive Levemir (Long-Acting) Insulin Overdose: Case Report  

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A 52-year-old insulin-dependant diabetic man presented to the Emergency Department 2 hours after a deliberate massive overdose of 2100 units of long-acting Levemir insulin and a large quantity of whisky. On initial assessment, his GCS was 3/15 and his capillary blood sugar was 2.6?mmol/L. The patient was given a 50?ml bolus of 50% dextrose, followed by intravenous infusions of both 5% and 10% dextrose. Despite the continuous infusions, he experienced 4 symptomatic hypoglycaemic episodes i...

2012-01-01

138

Pulsatile versus continuous intravenous administration of growth hormone (GH) in GH-deficient patients: effects on circulating insulin-like growth factor-I and metabolic indices  

DEFF Research Database (Denmark)

The episodic and pulsatile nature of GH secretion in normal man is well established. Studies in hypophysectomized rats have indicated that pulsatile administration of GH is superior to continuous infusion in promoting growth, but similar studies have not yet been conducted in human subjects. We compared three different iv GH administration schedules in six GH-deficient patients. They were hospitalized three times for 44 h on three occasions, separated by at least 4 weeks without GH treatment. On each occasion they received 2 IU GH, administered iv as either 1) two boluses (at 2000 and 0200 h), 2) eight boluses (at 3-h intervals starting at 2000 h), or 3) a continuous (2000-0200 h) infusion. Serum insulin-like growth factor-I (IGF-I) after eight boluses and that after continuous infusion were almost identical, with a steep increase reaching a peak at 2000-2400 h, followed by a steady decline. The total areas under the curve, expressed as mean levels (micrograms per L), were 147.6 +/- 11.8 (eight boluses) and 151.2 +/- 8.9 (infusion; P = NS). The change with time in IGF-I after the two-bolus regimen differed significantly from that in the other studies (P less than 0.001), displaying only a modest increase, as also reflected in a smaller area under the curve of serum IGF-I (125.3 +/- 8.7 micrograms/L; P less than 0.05). No differences in blood glucose, serum insulin, or plasma glucagon were observed when comparing the three studies. Both blood glucose and serum insulin tended to be elevated during the second night of each study. Almost identical fluctuations were recorded in lipid intermediates in the three studies, with nightly elevations being more pronounced on the first night. Alanine and lactate exhibited nearly identical patterns in the three studies and were characterized by low nocturnal levels. These data indicate that small but frequent iv boluses and continuous infusion of GH are equally effective in generating an increase in IGF-I in GH-deficient patients, whereas the same amount of GH given as two large boluses results in a significantly smaller increase in IGF-I. This could mean that a prolongation of the period during which serum GH is above zero in GH-treated subjects is just as essential as pulsatility for the growth-promoting effects of the hormone.

JØrgensen, J O; MØller, N

1990-01-01

139

Effect of intravenous infusion of dobutamine hydrochloride on the development of early postoperative cognitive dysfunction in elderly patients via inhibiting the release of tumor necrosis factor-?.  

Science.gov (United States)

To investigate the effects of dobutamine hydrochloride on early postoperative cognitive dysfunction (POCD) and plasma tumor necrosis factor (TNF)-? concentration in patients undergoing hip arthroplasty, 124 patients undergoing unilateral total hip arthroplasty, aged 70-92 years old, were randomly assigned to four groups (n=31) as follows: a control group of patients receiving only saline (intravenous infusion, i.v.); and groups receiving 2, 4, or 6?gkg(-1)min(-1) (i.v.) of dobutamine hydrochloride. Cognitive functions were assessed on the day before surgery (T1), and the 1st day (T2), 3rd day (T3), and 7th day (T4) postsurgery using the Mini Mental State Examination (MMSE). The plasma TNF-? protein level was determined 10min before anesthesia (Ta), and 10min (Tb), 30min (Tc), and 60min (Td) after anesthesia by an enzyme-linked immunosorbent assay. Cognitive disorder was observed within the first 3 days after hip arthroplastic surgery, and it had recovered 7 days after the operation in the control group of patients. Administration of 2 or 4?gkg(-1)min(-1) dobutamine hydrochloride was able to reverse the early POCD. Simultaneously, an increase of plasma TNF-? levels 30min after anesthesia was observed (41.34±9.61 vs. 27.75±5.45), which was significantly suppressed by the administration of low-dose dobutamine hydrochloride (29.23±7.32 vs. 41.34±9.61) but not by high-dose dobutamine hydrochloride (45.9±12.11 vs. 41.34±9.61). Together, our data indicated that the plasma concentration of TNF? was engaged in the effect of dobutamine hydrochloride on POCD. PMID:25131356

Sun, Defeng; Yang, Lin; Wu, Yue; Liu, Ruochuan; Han, Jun; Wang, Lijie

2014-10-15

140

Diferença entre volume de fluidos cristaloides intravenosos prescritos e infundidos em pacientes no pós-operatório precoce Difference between intravenous crystalloid fluids prescribed and infused in patients during early postoperative period  

Directory of Open Access Journals (Sweden)

Full Text Available OBJETIVO: O objetivo deste trabalho foi auditar a real quantidade de fluídos cristalóides infundidos por via intravenosa em pacientes submetidos a operações abdominais de grande porte num hospital universitário. MÉTODOS: Computou-se a carga hídrica total (CHT de fluidos cristalóides intravenosos infundida diariamente do 1º ao 4º dia de PO em 31 pacientes submetidos à operações de grande porte. Comparou-se a CHT com a carga hídrica prescrita (CHP pelo médico. A CHT foi definida como a somatória da CHP acrescida de diluentes e medicações intravenosas. O protocolo do serviço recomendava a hidratação venosa no peri-operatório entre 30 e 50 mL/Kg/dia em pacientes com prescrição de jejum oral. A comparação entre CHT e CHP foi realizada em todos os dias de pós-operatório pelo teste t pareado. Estabeleceu-se em 5% o nível de significância estatística. RESULTADOS: A CHT infundida do 1º ao 4ºdia de pós-operatório foi de 12,8 (6,4-17,5 L. Desse total, 9,5 litros (74,3% corresponderam a CHP e 3,3 L (25,7% a diluentes e medicações venosas. Em todos os dias de pós-operatório a CHT foi significativamente maior que a CHP (pOBJECTIVE: The aim of this study was to audit the real amount of crystalloid intravenous fluids infused in patients underwent major abdominal operations in a University hospital. METHODS: The whole intravenous crystalloid fluid load (CHT infused from the 1st to the 4th postoperative day in 31 patients underwent major abdominal operations was registered. This amount was compared to the volume daily prescribed (CHP by the physician. CHT was defined as the sum of CHP plus diluents and intravenous drugs received by the patients. Hydration protocol of the service was 30-50 mL/Kd/day for patient with nil per os prescription. Comparisons between CHT and CHP was done in each postoperative day using paired T test. A 5% level was established as significant. RESULTS: CHT summed from 1st to 4th PO days was (mean and range 12.8 (6.4-17.5 L corresponding to 9.5 L (74.3% of CHP and 3.3 L (25.7% of diluents and intravenous drugs. In each postoperative day, CHT was significantly greater than CHP (p<0.001. Until the 3rd PO day patients received a CHT greater than 50 mL/Kg/day. CONCLUSION:. Medical prescription does not contain the real amount of crystalloid intravenous fluids infused. Diluents and intravenous drug may reach 25% of the intravenous fluids load.

José Eduardo de Aguilar-Nascimento

2010-02-01

 
 
 
 
141

Microvascular Recruitment in Insulin Resistance  

DEFF Research Database (Denmark)

In this PhD work a new method for measuring microvascular recruitment was developed and evaluated, using continues real-time imaging of contrast enhanced ultrasound. Gas-filled microbubbles were infused intravenously and by taking advantage of the echogenic properties of the microbubbles the resonating sound from the microbubbles in the systemic circulation were recorded for determination of microvascular recruitment in designated muscle segments. Results showed that microvascular recruitment increased with insulin stimulation by ~30% in rats and ~40% in humans (study I). Furthermore, it was observed that muscle contractions increased muscle perfusion rapidly by 3-4 fold and by 1-2 fold compared to basal and insulin, respectively, in both rat and human skeletal muscle (study I). The real-time contrast-enhanced ultrasound method was applied to investigate the vaso-active effect of the incretin hormone glucagon-like-peptide-1 (GLP-1) in the microcirculation. Glucagon-like-peptide-1 analogs are drugs used for treatments of insulin resistance and type 2 diabetes but the vascular effects of GLP-1 in vivo are elusive. Here it was shown that GLP-1 rapidly increased the microvascular recruitment in human and rat skeletal muscle by ~60% and ~30%, respectively, and independently of insulin (study II and III). However, when rats consumed a 60 E% high fat diet acute administration of GLP-1 ameliorated both the early (5 days) and the more prolonged (8 weeks) high fat diet induced impairment of insulin action in the microvasculature and restored normal microvascular function by increasing the microvascular recruitment similar to in control animals. This effect of GLP-1 on microvascular recruitment was associated with a restoration of both whole body insulin sensitivity and muscle glucose uptake when co-infused with insulin in the 5 days but not in the 8 week high fat diet intervention. Thus, like insulin, GLP-1 increased microvascular recruitment but unlike insulin no direct effect on muscle glucose uptake of GLP-1 was observed.

SjØberg, Kim Anker

2014-01-01

142

The conversion of phenylalanine to tyrosine in man. Direct measurement by continuous intravenous tracer infusions of L-[ring-2H5]phenylalanine and L-[1-13C] tyrosine in the postabsorptive state  

International Nuclear Information System (INIS)

Steady state phenylalanine and tyrosine turnover and the rate of conversion of phenylalanine of tyrosine in vivo were determined in 6 healthy postabsorptive adult volunteers. Continuous infusions of tracer amounts of L-[ring-2H5]phenylalanine were determined intravenously for 13-14 hr. After 9-10 hr, a priming dose followed by a continuous infusion of L-[1-13C]tyrosine was added and maintained, along with the [2H5]phenylalanine infusion, for 4 hr. Venous plasma samples were obtained before the initiation of each infusion and every 30 min during the course of the combined [2H5]phenylalanine and [13C]tyrosine infusion for determination of isotopic enrichments of [2H5]phenylalanine, [13C]tyrosine, and [2H4]tyrosine by gas chromatograph-mass spectrometric analysis of the N-trifluoroacetyl-, methyl ester derivatives of the amino acids. Calculated from the observed enrichments, free phenylalanine and tyrosine turnover rates were 36.1 +/- 5.1 mumole . kg-1 . h-1 and 39.8 +/- 3.5 mumole . kg-1 . h-1, respectively. Phenylalanine was converted to tyrosine at the rate of 5.83 +/- 0.59 mumole . kg-1 . h-1, accounting for approximately 16% of either the phenylalanine or the tyrosine flux. The results indicate that the normal basal steady state phenylalanine hydroxylase activity in vivo in man is lower than that obtained from phenylalanine loading studies. This supports the existence of some type of substance activation of the enzyme as reflected in the previously reported exponential relationship between phenylalanine concentration and phenylalanine hydroxylase activity in vitro. The use of continuous simultaneous infusions of tracer amounts of stable isotope-labeled phenylalanine and tyrosine provides a direct means for studying physiological regulation of phenylalanine hydroxylase activity in vivo

143

Infusão de insulina em terapia intensiva: ensaio controlado randomizado / Insulin infusion in intensive care: randomized controlled trial / Infusion de insulina en cuidados intensivos: ensayo controlado aleatorizado  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese Ensaio clínico controlado e aleatorizado que comparou o uso de protocolo de insulina intensivo e convencional na evolução clínica de pacientes em sepse grave e choque séptico, nas primeiras 72 h. Foi conduzido em um hospital universitário na cidade de São Paulo. Os pacientes (n=46) foram alocados e [...] m dois grupos: glicêmico intensivo (glicemia entre 80-110mg/dl) e convencional (180-220mg/dl). Utilizaram-se testes t-Student e Qui-Quadrado na análise dos dados. Observou-se diferença estatisticamente significativa (p Abstract in spanish Ensayo clínico aleatorio controlado y randomizado que comparó el uso de protocolo de insulina intensivo y convencional en la evolución clínica de pacientes en sepsis grave y shock séptico, en las primeras 72 horas. Fue realizado en un hospital universitario de la ciudad de São Paulo. Los pacientes [...] (n=46) fueron distribuidos en dos grupos: glucémico intensivo (glucemia entre 80-110mg/dl) y convencional (180-220mg/dl). Se utilizaron tests t-Student y Chi-cuadrado para análisis de los datos. Se observó diferencia estadísticamente significativa (p Abstract in english This randomized controlled trial compared the use of an intensive and conventional insulin protocol on clinical outcomes in patients with severe sepsis and septic shock, in the first 72 hours. It was conducted at a university hospital in the city of São Paulo. Patients (n=46) were allocated into tw [...] o groups: intensive glycemic (blood glucose between 80-110mg/dl) and conventional (180-220mg/dl). The Student's t-test and chi-square test were used for data analysis. A statistically significant (p

Milena Penteado Ferraro, Miranda; Jeiel Carlos Lamonica, Crespo; Silvia Regina, Secoli.

2013-06-01

144

A fatty acid- dependent step is critically important for both glucose- and non-glucose-stimulated insulin secretion.  

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Lowering of the plasma FFA level in intact fasted rats by infusion of nicotinic acid (NA) caused essentially complete ablation of insulin secretion (IS) in response to a subsequent intravenous bolus of arginine, leucine, or glibenclamide (as previously found using glucose as the beta-cell stimulus). However, in all cases, IS became supranormal when a high FFA level was maintained by co-infusion of lard oil plus heparin. Each of these secretagogues elicited little, if any, IS from the isolated...

Dobbins, R. L.; Chester, M. W.; Stevenson, B. E.; Daniels, M. B.; Stein, D. T.; Mcgarry, J. D.

1998-01-01

145

Completa recuperación de grave síndrome de hueso hambriento usando infusión crónica ambulatoria de calcio intravenoso: Caso clínico / Complete recovery of life-threatening hungry bone syndrome using long-term ambulatory intravenous calcium infusion: Report of one case  

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish [...] Abstract in english We report a 29 years old woman with a highly symptomatic primary hyperparathyroidism. After parathyroid adenoma excision, she presented a prolonged and life threatening hypocalcemia, due to a severe hungry bone syndrome. Conventional treatment with oral and intravenous calcium and calcitriol supplem [...] entation failed to raise serum and urinary calcium or to relief symptoms. After one month, we indicated a continuous intravenous calcium infusion allowing, during 6 months, an adequate outpatient management. Initial T scores for bone density were markedly low (L2-L4: -3.14; femoral neck: -3.07) and they increased 17% after 18 days of calcium infusion. After 147 days of treatment bone density was normal, increasing by 61%. The present case shows that the hungry bone syndrome can be a real risk for patients and a complex therapeutic challenge. With an appropriate calcium supply an early, fast and complete recovery of bone mass can be achieved (Rev Méd Chile 2003; 131: 779-84)

Claudia, Campusano M; José Manuel, López M.

146

Effects of insulin, recombinant bovine somatotropin, and their interaction on insulin-like growth factor-I secretion and milk protein production in dairy cows.  

Science.gov (United States)

This trial was designed to test the effects of insulin, recombinant bovine somatotropin (rbST), and their interaction on milk protein and selected blood parameters in dairy cows. Eight Holstein cows (86 +/- 10 d in milk) were divided in two groups and used in two replicates of a Latin square design with four animals, four periods, and four treatments: 1) intravenous infusion of saline, 2) infusion of saline and subcutaneous administration of 40 mg of rbST per day, 3) intravenous infusion of 12 mg of insulin per day coupled with glucose infusion, and 4) rbST administration combined with insulin and glucose infusion. The glucose infusion rate was adjusted to maintain euglycemia. Each experimental period lasted 14 d: treatments were administered during the first 6 d, and no treatment was administered during the following 8-d resting phase. The average daily amount of glucose infusion needed to avoid hypoglycemia was 2.8 kg/cow when only insulin was infused as opposed to 2.2 kg/cow when both insulin and rbST were administered, indicating that either rbST causes a peripheral resistance to insulin or rbST increased liver gluconeogenesis or both. Data from the last 3 d of infusion were analyzed by using the SAS system for mixed models. Percent protein of milk tended to be lower (2.84 vs. 2.79%) and milk urea content was lower (16.6 vs. 14.8 mg/dl) during rbST administration, regardless of insulin infusion. Insulin infusion increased percent protein (2.78 vs. 2.85%) and percent casein (2.36 vs. 2.46%) and decreased milk urea content (17.1 vs. 14.3 mg/dl) regardless of rbST administration. For milk yield, protein yield, casein yield, lactose percent, and lactose yield, there were significant interactions between insulin and rbST administration. For example, casein yield averaged 1.17, 1.12, 1.20, and 1.28 kg/d for saline, insulin, rbST, and insulin combined with rbST, respectively. Similarly, there was a significant interaction between insulin and rbST on IGF-I levels, which were 122.5, 181.3, 342.3, and 492.2 ng/ml for saline, insulin, rbST, and insulin combined with rbST, respectively. In conclusion, these results clearly demonstrated that insulin interacts with bST in early lactation to improve milk protein synthesis and yield in dairy cows. These effects are probably mediated through a combination of bST nutrient mobilization, bST-induced gluconeogenesis, bST-induced insulin peripheral resistance, and bST/insulin synergism on insulin-like growth factor-I secretion and on mammary epithelial tissue. PMID:12018418

Molento, C F M; Block, E; Cue, R I; Petitclerc, D

2002-04-01

147

The use of a volumetric infusion pump for the intra-arterial infusion of drugs.  

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Volumetric infusion pumps are widely used for intravenous infusions. We have extended their use to the intra-arterial infusion of drugs. An in vitro evaluation of the performance of such devices, under experimental conditions comparable to an intra-arterial infusion, was carried out. The results obtained confirmed the accuracy of volumetric infusion pumps for intra-arterial infusions. The system was found to be safe, reliable and simple in clinical practice.

Cooper, A. M.; Lilliman, M.

1985-01-01

148

Effect of intravenous omega-3 fatty acid infusion and hemodialysis on fatty acid composition of free fatty acids and phospholipids in patients with end-stage renal disease  

DEFF Research Database (Denmark)

Patients treated with hemodialysis (HD) have been reported to have decreased levels of ?-3 polyunsaturated fatty acids (PUFAs) in plasma and cells. The aim of this study was to investigate the effect of ?-3 PUFAs administered intravenously during HD, as well as the effect of HD treatment, on the fatty acid composition of plasma free fatty acids (FFAs), plasma phospholipids, and platelet phospholipids.

Madsen, Trine; Christensen, Jeppe Hagstrup

2011-01-01

149

Hypoglycaemia secondary to labetalol infusion.  

Science.gov (United States)

A 42-year-old multigravida with severe pre-eclampsia had an emergency caesarean section under spinal anaesthesia. Peri-operatively, her arterial pressure was controlled with oral methyldopa and an intravenous infusion of labetalol. Postoperatively, in the Intensive Care Unit, she had recurrent episodes of hypoglycaemia which required treatment with intravenous glucose. These episodes resolved when the labetalol infusion was stopped. Clinicians should be aware of the potential of labetalol to cause hypoglycaemia. PMID:21575539

Immanni, Sudhir; Khan, Ehtesham Izhar; Staunton, Michael

2011-05-01

150

Diferença entre volume de fluidos cristaloides intravenosos prescritos e infundidos em pacientes no pós-operatório precoce / Difference between intravenous crystalloid fluids prescribed and infused in patients during early postoperative period  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese OBJETIVO: O objetivo deste trabalho foi auditar a real quantidade de fluídos cristalóides infundidos por via intravenosa em pacientes submetidos a operações abdominais de grande porte num hospital universitário. MÉTODOS: Computou-se a carga hídrica total (CHT) de fluidos cristalóides intravenosos in [...] fundida diariamente do 1º ao 4º dia de PO em 31 pacientes submetidos à operações de grande porte. Comparou-se a CHT com a carga hídrica prescrita (CHP) pelo médico. A CHT foi definida como a somatória da CHP acrescida de diluentes e medicações intravenosas. O protocolo do serviço recomendava a hidratação venosa no peri-operatório entre 30 e 50 mL/Kg/dia em pacientes com prescrição de jejum oral. A comparação entre CHT e CHP foi realizada em todos os dias de pós-operatório pelo teste t pareado. Estabeleceu-se em 5% o nível de significância estatística. RESULTADOS: A CHT infundida do 1º ao 4ºdia de pós-operatório foi de 12,8 (6,4-17,5) L. Desse total, 9,5 litros (74,3%) corresponderam a CHP e 3,3 L (25,7%) a diluentes e medicações venosas. Em todos os dias de pós-operatório a CHT foi significativamente maior que a CHP (p Abstract in english OBJECTIVE: The aim of this study was to audit the real amount of crystalloid intravenous fluids infused in patients underwent major abdominal operations in a University hospital. METHODS: The whole intravenous crystalloid fluid load (CHT) infused from the 1st to the 4th postoperative day in 31 patie [...] nts underwent major abdominal operations was registered. This amount was compared to the volume daily prescribed (CHP) by the physician. CHT was defined as the sum of CHP plus diluents and intravenous drugs received by the patients. Hydration protocol of the service was 30-50 mL/Kd/day for patient with nil per os prescription. Comparisons between CHT and CHP was done in each postoperative day using paired T test. A 5% level was established as significant. RESULTS: CHT summed from 1st to 4th PO days was (mean and range) 12.8 (6.4-17.5) L corresponding to 9.5 L (74.3%) of CHP and 3.3 L (25.7%) of diluents and intravenous drugs. In each postoperative day, CHT was significantly greater than CHP (p

José Eduardo de, Aguilar-Nascimento; Breno Nadaf, Diniz; José de Souza, Neves.

2010-02-01

151

Breadboard development of a fluid infusion system  

Science.gov (United States)

A functional breadboard of a zero gravity Intravenous Infusion System (IVI) is presented. Major components described are: (1) infusate pack pressurizers; (2) pump module; (3) infusion set; and (4) electronic control package. The IVI breadboard was designed to demonstrate the feasibility of using the parallel solenoid pump and spring powered infusate source pressurizers for the emergency infusion of various liquids in a zero gravity environment. The IVI was tested for flow rate and sensitivity to back pressure at the needle. Results are presented.

Thompson, R. W.

1974-01-01

152

MATLAB-implemented estimation procedure for model-based assessment of hepatic insulin degradation from standard intravenous glucose tolerance test data.  

Science.gov (United States)

Present study provides a novel MATLAB-based parameter estimation procedure for individual assessment of hepatic insulin degradation (HID) process from standard frequently-sampled intravenous glucose tolerance test (FSIGTT) data. Direct access to the source code, offered by MATLAB, enabled us to design an optimization procedure based on the alternating use of Gauss-Newton's and Levenberg-Marquardt's algorithms, which assures the full convergence of the process and the containment of computational time. Reliability was tested by direct comparison with the application, in eighteen non-diabetic subjects, of well-known kinetic analysis software package SAAM II, and by application on different data. Agreement between MATLAB and SAAM II was warranted by intraclass correlation coefficients ?0.73; no significant differences between corresponding mean parameter estimates and prediction of HID rate; and consistent residual analysis. Moreover, MATLAB optimization procedure resulted in a significant 51% reduction of CV% for the worst-estimated parameter by SAAM II and in maintaining all model-parameter CV% MATLAB-based procedure was suggested as a suitable tool for the individual assessment of HID process. PMID:23122301

Di Nardo, Francesco; Mengoni, Michele; Morettini, Micaela

2013-05-01

153

Lead and zinc concentrations in plasma, erythrocytes, and urine in relation to ALA-D activity after intravenous infusion of Ca-EDTA.  

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Lead and zinc concentrations in plasma, erythrocytes, and urine, urinary ALA concentration, and ALA-D activity in blood were studied for four hours in two male lead workers during and after a one hour infusion of Ca-EDTA 2Na. Urinary and plasma lead concentrations increased as a result of administering Ca-EDTA 2Na, and the ratios of lead concentrations in plasma to those in urine were greatly increased. The increase of plasma lead concentration was not due to the haemolytic effect of Ca-EDTA ...

Ishihara, N.; Shiojima, S.; Hasegawa, K.

1984-01-01

154

Anesthesia with propofol induces insulin resistance systemically in skeletal and cardiac muscles and liver of rats  

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Highlights: ? Propofol, as a model anesthetic drug, induced whole body insulin resistance. ? Propofol anesthesia decreased glucose infusion rate to maintain euglycemia. ? Propofol decreased insulin-mediated glucose uptake in skeletal and cardiac muscles. ? Propofol increased hepatic glucose output confirming hepatic insulin resistance. -- Abstract: Hyperglycemia together with hepatic and muscle insulin resistance are common features in critically ill patients, and these changes are associated with enhanced inflammatory response, increased susceptibility to infection, muscle wasting, and worsened prognosis. Tight blood glucose control by intensive insulin treatment may reduce the morbidity and mortality in intensive care units. Although some anesthetics have been shown to cause insulin resistance, it remains unknown how and in which tissues insulin resistance is induced by anesthetics. Moreover, the effects of propofol, a clinically relevant intravenous anesthetic, also used in the intensive care unit for sedation, on insulin sensitivity have not yet been investigated. Euglycemic hyperinsulinemic clamp study was performed in rats anesthetized with propofol and conscious unrestrained rats. To evaluate glucose uptake in tissues and hepatic glucose output [{sup 3}H]glucose and 2-deoxy[{sup 14}C]glucose were infused during the clamp study. Anesthesia with propofol induced a marked whole-body insulin resistance compared with conscious rats, as reflected by significantly decreased glucose infusion rate to maintain euglycemia. Insulin-stimulated tissue glucose uptake was decreased in skeletal muscle and heart, and hepatic glucose output was increased in propofol anesthetized rats. Anesthesia with propofol induces systemic insulin resistance along with decreases in insulin-stimulated glucose uptake in skeletal and heart muscle and attenuation of the insulin-mediated suppression of hepatic glucose output in rats.

Yasuda, Yoshikazu; Fukushima, Yuji; Kaneki, Masao [Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Shriners Hospitals for Children, Harvard Medical School, Boston, MA 02114 (United States); Martyn, J.A. Jeevendra, E-mail: jmartyn@partners.org [Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Shriners Hospitals for Children, Harvard Medical School, Boston, MA 02114 (United States)

2013-02-01

155

Anesthesia with propofol induces insulin resistance systemically in skeletal and cardiac muscles and liver of rats  

International Nuclear Information System (INIS)

Highlights: ? Propofol, as a model anesthetic drug, induced whole body insulin resistance. ? Propofol anesthesia decreased glucose infusion rate to maintain euglycemia. ? Propofol decreased insulin-mediated glucose uptake in skeletal and cardiac muscles. ? Propofol increased hepatic glucose output confirming hepatic insulin resistance. -- Abstract: Hyperglycemia together with hepatic and muscle insulin resistance are common features in critically ill patients, and these changes are associated with enhanced inflammatory response, increased susceptibility to infection, muscle wasting, and worsened prognosis. Tight blood glucose control by intensive insulin treatment may reduce the morbidity and mortality in intensive care units. Although some anesthetics have been shown to cause insulin resistance, it remains unknown how and in which tissues insulin resistance is induced by anesthetics. Moreover, the effects of propofol, a clinically relevant intravenous anesthetic, also used in the intensive care unit for sedation, on insulin sensitivity have not yet been investigated. Euglycemic hyperinsulinemic clamp study was performed in rats anesthetized with propofol and conscious unrestrained rats. To evaluate glucose uptake in tissues and hepatic glucose output [3H]glucose and 2-deoxy[14C]glucose were infused during the clamp study. Anesthesia with propofol induced a marked whole-body insulin resistance compared with conscious rats, as reflected by significantly decreased glucose infusion rate to maintain euglycemia. Insulin-stimulated tissue glucose uptake was decreased in skeletal muscle and heart, and hepatic glucose output was increased in propofol anesthetized rats. Anesthesia with propofol induces systemic insulin resistance along with decreases in insulin-stimulated glucose uptake in skeletal and heart muscle and attenuation of the insulin-mediated suppression of hepatic glucose output in rats

156

Estudos hemodinâmicos e da função endotelial em porcas saudáveis após injeção em bolus endovenoso de azul de metileno / Hemodynamic and vascular endothelium function studies in healthy pigs after intravenous bolus infusion of methylene blue  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese OBJETIVO: Benefícios clínicos obtidos pelo azul de metileno (AM) no tratamento da vasoplegia induzida pela ação do óxido nítrico (NO) têm sido relatados na sepse, na síndrome da resposta inflamatória sistêmica (SIRS) em cirurgia cardíaca e no choque anafilático, mas a sua segurança é muitas vezes qu [...] estionada, principalmente relacionada aos seus efeitos hemodinâmicos e à possibilidade de causar disfunção endotelial. O objetivo deste estudo foi examinar os efeitos hemodinâmicos e a função endotelial da infusão endovenosa in vivo do AM em porcos. MÉTODOS: O protocolo de estudo incluiu dois grupos experimentais de porcas fêmeas: Grupo I (Controle) - os animais (n = 6) não receberam AM; Grupo II (AM) - os animais receberam 3 mg/kg de AM em forma de bolus endovenoso. Após quinze minutos de registro dos parâmetros hemodinâmicos os animais foram sacrificados por exsangüinação, e os estudos in vitro foram conduzidos usando segmentos de artérias coronária, hepática, mesentérica superior, renal, para determinar o efeito do AM na função endotelial relacionada com a liberação de NO. Mediu-se também o NO plasmático nos dois grupos experimentais. RESULTADOS: Os resultados obtidos no presente estudo foram: 1) a infusão endovenosa de AM (3,0 mg/kg) não causou nenhuma alteração hemodinâmica significativa; 2) os valores absolutos e porcentuais e nitrito/nitrato plasmático (NOx) não apresentaram diferenças nos dois grupos experimentais; 3) o estudo in vitro dos segmentos arteriais (coronária, hepática, renal e mesentérica superior) não apresentou disfunção endotelial nos dois grupos. Os resultados sugerem que a injeção endovenosa de AM é segura. Esse dado concorda com dados clínicos no qual o AM foi utilizado para tratar a síndrome vasoplégica após circulação extracorpórea, síndrome da resposta infamatória sistêmica (SIRS) e anafilaxia. Os resultados não foram inesperados porque os animais não apresentavam vasoplegia, não se esperando que a inibição da guanilatociclase tenha algum efeito. CONCLUSÃO: A infusão em bolus endovenoso in vivo na dose investigada (3 mg/kg) não causou alterações hemodinâmicas e comprometimento da liberação in vitro de NO. Abstract in english OBJECTIVE: Clinical benefit of methylene blue (MB) treating NO-induced vasoplegia has been reported in sepsis, systemic inflammatory response syndrome (SIRS) in cardiac surgery and anaphylactic shock, but its safety is sometimes questioned, mainly regarding its hemodynamic effects and the possibilit [...] y of causing endothelium dysfunction. To examine the nitric oxide plasma levels and cardiovascular effects of the infusion of MB in vivo and its effects on endothelium-dependent and endothelium-independent in vitro vascular relaxation. METHODS: The study protocol included two experimental groups of female pigs: Group I (Control) - the animals (n=6) did not receive MB; Group II (MB) - the animals received 3 mg/kg of MB intravenous bolus infusion. After fifteen minutes of hemodynamic parameter recording the animals were sacrificed by exsanguination, and in vitro studies were conducted using segments of coronary, hepatic, superior mesenteric and renal arteries, to determine the effect of MB on the arterial endothelium function with regard to NO release. Nitric oxide plasma levels (NOx) were measured in each of the experimental groups. RESULTS: The results obtained in the present investigation were: 1) intravenous infusion of MB (3.0 mg/kg) caused no hemodynamic changes; 2) absolute and percent plasma NOx values did not differ between the experimental groups; and 3) in vitro study of vascular relaxation showed no significant difference between groups. These results show that MB intravenous infusion seems to be safe. This finding agrees with data from clinical experiments where MB was used to treat vasoplegic syndrome after cardiopulmonary bypass, systemic inflammatory response syndrome (SIRS) and anaphylaxis. These

Antonio Carlos, Menardi; Fernanda, Viaro; Walter Vilella de Andrade, Vicente; Alfredo José, Rodrigues; Paulo Roberto Barbosa, Évora.

157

Calcineurin inhibitors acutely improve insulin sensitivity without affecting insulin secretion in healthy human volunteers  

DEFF Research Database (Denmark)

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: New Onset Diabetes After Transplantation is related to treatment with immunosuppressive medica-tions. Clinical studies have shown that risk of new onset diabetes is greater with tacrolimus compared with cyclosporine. The diabetogenicity of cyclosporine and tacrolimus has been attributed to both beta cell dysfunction and impaired insulin sensitivity. WHAT THIS STUDY ADDS: This is the first trial to investigate beta cell function and insulin sensitivity using gold standard methodology in healthy human volunteers treated with clinically relevant doses of cyclosporine and tacrolimus. We document that both drugs acutely increase insulin sensitivity, while first phase and pulsatile insulin secretion remain unaffected. This study demonstrates that cyclosporine and tacrolimus have similar acute effects on glucose metabolism in healthy humans. ABSTRACT: BACKGROUND AND PURPOSE. Introducing the calcineurin inhibitors (CNIs) cyclosporine (CsA) and tacrolimus (Tac) has improved the outcome of organ transplants, but complications such as New Onset Diabetes mellitus After Transplantation (NODAT) cause impairment of survival rates. The relative contribution of each CNI to the pathogenesis and development of NODAT remains unclear. We sought to compare the impact of CsA and Tac on glucose metabolism in human subjects. EXPERIMENTAL APPROACH. Ten healthy men underwent 5-hour infusions of CsA, Tac and saline in a randomized, double-blind, cross-over study. During infusion glucose metabolism was investigated using following methods: A hyperinsulinemic-euglycemic clamp, an intravenous glucose tolerance test (IVGTT), glucose-stimulated insulin concentration time-series and indirect calorimetry. RESULTS. Clamp derived insulin sensitivity was increased by 25 % during CsA (P <0.0001) and 13 % during Tac administration (P= 0.047), whereas first phase and pulsatile insulin secretion were unaffected. Coinciding with the CNI induced improved insulin sensitivity, glucose oxidation rates increased, whileinsulin clearance rates decreased, only non-significantly. Tac singularly lowered hsCRP levels, otherwise no changes were observed in circulating glucagon, FFA or adiponectin levels. Mean blood levels of CNIs were 486.9 ± 23.5 ?g/l for CsA and 12.8 ± 0.5 ?g/l for Tac. CONCLUSIONS. In conclusion acute effects of intravenous CsA and to a lesser degree Tac infusions in healthy volunteers include increased insulin sensitivity, without any effect on first phase or pulsatile insulin secretion.

Øzbay, Aygen; MØller, Niels

2012-01-01

158

Medanta insulin protocols in patients undergoing cardiac surgery  

Science.gov (United States)

Hyperglycemia is common in patients undergoing cardiac surgery and is associated with poor outcomes. This is a review of the perioperative insulin protocol being used at Medanta, the Medicity, which has a large volume cardiac surgery setup. Preoperatively, patients are usually continued on their preoperative outpatient medications. Intravenous insulin infusion is intiated postoperatively and titrated using a column method with a choice of 7 scales. Insulin dose is calculated as a factor of blood glucose and patient's estimated insulin sensitivity. A comparison of this protocol is presented with other commonly used protocols. Since arterial blood gas analysis is done every 4 hours for first two days after cardiac surgery, automatic data collection from blood gas analyzer to a central database enables collection of glucose data and generating glucometrics. Data auditing has helped in improving performance through protocol modification. PMID:25143899

Bansal, Beena; Mithal, Ambrish; Carvalho, Pravin; Mehta, Yatin; Trehan, Naresh

2014-01-01

159

Medanta insulin protocols in patients undergoing cardiac surgery.  

Science.gov (United States)

Hyperglycemia is common in patients undergoing cardiac surgery and is associated with poor outcomes. This is a review of the perioperative insulin protocol being used at Medanta, the Medicity, which has a large volume cardiac surgery setup. Preoperatively, patients are usually continued on their preoperative outpatient medications. Intravenous insulin infusion is intiated postoperatively and titrated using a column method with a choice of 7 scales. Insulin dose is calculated as a factor of blood glucose and patient's estimated insulin sensitivity. A comparison of this protocol is presented with other commonly used protocols. Since arterial blood gas analysis is done every 4 hours for first two days after cardiac surgery, automatic data collection from blood gas analyzer to a central database enables collection of glucose data and generating glucometrics. Data auditing has helped in improving performance through protocol modification. PMID:25143899

Bansal, Beena; Mithal, Ambrish; Carvalho, Pravin; Mehta, Yatin; Trehan, Naresh

2014-07-01

160

Pharmacokinetics of perfluorobutane following intravenous bolus injection and continuous infusion of sonazoid in healthy volunteers and in patients with reduced pulmonary diffusing capacity.  

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The ultrasound contrast agent Sonazoidtrade mark was administered as an i.v. bolus injection of 0.6 microL microbubbles/kg body weight or as a continuous infusion over 30 min at a rate of 1.2 microL microbubbles/kg body weight to healthy volunteers and patients with reduced pulmonary diffusing capacity. Expired air and blood samples were collected from 32 subjects and perfluorobutane (PFB) gas was analyzed using validated gas chromatography mass spectrometry methods. Blood concentrations of PFB declined biphasicly with a distribution half-life (t(0.5 to 15)) of 2 to 3 min and an elimination half-life (t(15 to 120)) of 30 to 45 min. Area under the curve (AUC) values in patients with impaired gas diffusion were significantly larger than those in healthy volunteers. The exhalation kinetics were somewhat variable with a PFB elimination half-life (t(15 to 120)) of 28 to 111 min. Clearance of PFB was independent of study population and mode of administration. There were no deaths and no serious adverse events that resulted in the withdrawal of a subject from the study. With the exception that arthralgia predominated in healthy volunteers, healthy volunteers and diseased subjects did not show a different adverse event profile whether Sonazoid was administered as a bolus injection or as an infusion. Assessment of laboratory parameters (serum biochemistry, haematology and urinalysis), vital signs, oxygen saturation and electrocardiograms (ECGs) showed no changes which caused safety concern. (E-mail: Kristin.Landmark@ge.com). PMID:18096304

Landmark, Kristin Eitrem; Johansen, Per Wiik; Johnson, Judith A; Johansen, Bjørn; Uran, Steinar; Skotland, Tore

2008-03-01

 
 
 
 
161

Is the Tecoma stans infusion an antidiabetic remedy?  

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The intravenous administration of Tecoma stans infusion in normal dogs produces an early hyperglycemic response and arterial hypotension followed by a slow decrease of the glucose blood values with a concomitant hypertriglyceridemia; no important changes in immunoreactive insulin were detected. Heart frequency was gradually increased after the first 60 min of drug administration and persisted for several hours. The effects observed on blood parameters seem to be related to hepatic glycogen metabolism, involving an activation of glycogenolysis. The late hypoglycemic effect of Tecoma stans infusion could be considered secondary to the observed hepatic glucose output. The study represents an attempt to elucidate the popularly attributed antidiabetic properties of this Mexican medicinal plant. PMID:3910963

Lozoya-Meckes, M; Mellado-Campos, V

1985-09-01

162

Effect of short-term intralipid infusion on the immune response during low-dose endotoxemia in humans  

DEFF Research Database (Denmark)

Novel anti-inflammatory effects of insulin have recently been described, and insulin therapy to maintain euglycemia suppresses the plasma levels of free fatty acids (FFA) and increases the survival of critically ill patients. We aimed to explore the effect of short-term high levels of plasma FFA on the inflammatory response to a low dose of endotoxin. Fourteen healthy male volunteers underwent the following two trials in a randomized crossover design: 1) continuous infusion of 20% Intralipid [0.7 ml.kg(-1).h(-1) (1.54 g/kg)] for 11 h, and 2) infusion of isotonic saline for 11 h (control). In each trial, heparin was given to activate lipoprotein lipase, and an intravenous bolus of endotoxin (0.1 ng/kg) was given after 6 h of Intralipid/saline infusion. Blood samples and muscle and fat biopsies were obtained before the Intralipid/saline infusion and before as well as after infusion of an endotoxin bolus. Plasma levels of FFA, triglycerides, and glycerol were markedly increased during the Intralipid infusion. Endotoxin exposure induced an increase in plasma levels of TNF-alpha, IL-6, and neutrophils and further stimulated gene expression of TNF-alpha and IL-6 in both skeletal muscle and adipose tissue. The systemic inflammatory response to endotoxin was significantly pronounced during Intralipid infusion. Short-term hyperlipidemia enhances the inflammatory response to endotoxin, and skeletal muscle and adipose tissue are capable of producing essential inflammatory mediators after endotoxin stimulation Udgivelsesdato: 2008/2

Krogh-Madsen, R.; Plomgaard, P.

2008-01-01

163

Use of real time continuous glucose monitoring and intravenous insulin in type 1 diabetic mothers to prevent respiratory distress and hypoglycaemia in infants  

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Full Text Available Abstract Background Pregnancy in Type 1 diabetic patients is a precarious condition, both for mother and fetus with increased the risk of prematurity and, immediately after delivery with risk of respiratory distress syndrome and hypoglycaemia in newborns. A strict control and monitoring of diabetes throughout pregnancy is important in reducing the impact of the disease on the fetus and newborn. In recent years many new technologies have been introduced to ameliorate diabetes monitoring, where the last is the Real-time Continuous Glucose Monitoring System (RT-CGMS. Methods In the last three years, 72 h continuous glucose monitoring system (RT-CGMS (Medtronic, CA was performed in 18 pregnant women with Type 1 diabetes in two moments of pregnancy: during treatment with betamethasone to prevent respiratory distress and during delivery. In both cases insulin was administered intravenous and the dose was changed on the basis of glycaemia. Results The results present the use of this new technique during two topics moments of pregnancy of type 1 diabetes patients when is very important intensively to monitor diabetes and to obtain the well being of the fetus. No infant experimented hypoglycaemia or respiratory distress syndrome at the moment and in the first hours after the birth. Conclusion We wish to stress the importance reducing glycaemia during administration of betamethasone and during labor. It is conceivable that the scarce attention paid to monitoring glucose levels in diabetic mothers during labor in gynaecological world may be due to the difficulty in glucose monitoring with the devices until now available. Hopefully, our anecdotal account may prompt improvements with RT-CGMS, and may lead to a better approach to the problem, thereby changing the prognosis of infants born to diabetic mothers.

Passaro Patrizia

2008-07-01

164

Fiscal 2000 achievement report on the research and development of medical and welfare apparatus/technology. Implantable insulin infusion system utilizing optical blood glucose monitor; 2000 nendo iryo fukushi kiki gijutsu kenkyu kaihatsu seika hokokusho. Kogakuteki kettochi sokutei system wo oyoshita tainai umekomigata insulin chunyu system  

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In the study of an optical blood glucose monitoring system, basic data were collected and studied by measuring, for example, the absorption spectra of a glucose solution and rabbit blood in the near infrared domain. A simulation program was prepared based on the Monte Carlo method for the reproduction of light propagation in living organisms. As for the implanted insulin infusion system, requirements to be satisfied, technical problems to solve for their satisfaction, and system specifications were studied. As for the insulin infusion pump, methods for pump driving, manufacturing, and evaluating were studied, and a diaphragm type pump was fabricated. As for percutaneous signal transmission, studies were made about information to be transmitted and received between the intracorporeal and extracorporeal units, method of communication, charging of power to the intracorporeal unit, and so forth. (NEDO)

NONE

2001-05-01

165

Glucoregulation after canine islet transplantation: contribution of insulin secretory capacity, insulin action, and the entero-insular axis.  

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The physiological glucoregulatory mechanisms after islet transplantation have been incompletely investigated. We studied the insulin secretory capacity (ISC) by intravenous arginine stimulation during 35-mM glucose clamps, insulin action during hyperinsulinemic euglycemic clamps, and mixed-meal stimulation at 6-9 mo after intrasplenic islet autotransplantation in 8 dogs, as compared with 30 controls. The enteroinsular axis in the recipients was examined by infusion of porcine glucose-dependent insulinotropic polypeptide (GIP) and human glucagon-like peptide-1 (GLP-1) (7-36 amide) under 8.5-mM glycemic clamp conditions in order to mimic the postprandial glycemia after transplantation. The grafts comprised 25% of the native islet mass, and the ISC likewise averaged 25% of the control value. The postprandial insulin response, in contrast, had increased to 140% after transplantation--albeit with a concomitant glucose excursion to approximately 8.5 mM. Insulin action declined on average by 45% posttransplant. The ISC correlated both with the postprandial glucose excursion and insulin action in the grafted dogs. Insulin action did not correlate with the postprandial glucose excursion. Infusion of GIP had no effect, but GLP-1 nearly doubled glucose-stimulated insulin. Thus, a hyperglycemia-enhanced insulinotropic effect of GLP-1, and perhaps other gut hormones, may account for the difference in the insulin response to the intravenous and oral challenges. Because the ISC reflects the engrafted islet mass and appears to be the primary determinant of glucose tolerance, transplantation of higher islet doses should allow prolonged near-normal glucoregulation--at least in the autotransplant setting. PMID:9331501

van der Burg, M P; van Suylichem, P T; Guicherit, O R; Frölich, M; Lemkes, H H; Gooszen, H G

1997-01-01

166

Safety and pharmacokinetics of 120 mg/kg versus 60 mg/kg weekly intravenous infusions of alpha-1 proteinase inhibitor in alpha-1 antitrypsin deficiency: a multicenter, randomized, double-blind, crossover study (SPARK).  

Science.gov (United States)

Augmentation therapy with the approved dose of 60 mg/kg weekly intravenous (IV) alpha-1 proteinase inhibitor (alpha1-PI), achieves a trough serum level of 11 ?M in individuals with alpha-1 antitrypsin deficiency (AATD), yet this is still below the level observed in healthy individuals. This study assessed the safety and pharmacokinetic profile of weekly infusions of a 120 mg/kg dose of alpha1-PI in 30 adults with AATD. Subjects with symptomatic, genetically determined (genotypes PI*ZZ, PI*Z(null), PI*(null)(null) or PI*(Z)Mmalton) AATD were randomly assigned to weekly infusions of 60 or 120 mg/kg alpha1-PI (Prolastin-C®) for 8 weeks before crossing over to the alternate dose for 8 weeks. Adverse events (AEs) (including exacerbations), vital signs, pulmonary function tests, and laboratory assessments were recorded. Pharmacokinetic measurements included AUC0-7days, Cmax, trough, tmax, and t1/2, based on serum alpha1-PI concentrations. In total for both treatments, 112 AEs were reported, with exacerbation of COPD being the most frequent, consistent with the subjects' diagnoses. Mean steady-state serum alpha1-PI concentrations following 120 mg/kg weekly IV alpha1-PI were higher than with the 60 mg/kg dose and mean trough concentrations were 27.7 versus 17.3 ?M, respectively. Dose proportionality was demonstrated for AUC0-7days and Cmax, with low inter-subject variability. The 120 mg/kg alpha1-PI weekly dose was considered to be safe and well tolerated, and provided more favorable physiologic alpha1-PI serum levels than the currently recommended 60 mg/kg dose. The effect of this dosing regimen on slowing and/or preventing emphysema progression in subjects with AATD warrants further investigation. PMID:23862647

Campos, Michael A; Kueppers, Friedrich; Stocks, James M; Strange, Charlie; Chen, Junliang; Griffin, Rhonda; Wang-Smith, Laurene; Brantly, Mark L

2013-12-01

167

O eletrencefalograma nas hemorragias uterinas disfuncionais: ação dos estrogênios por via intravenosa / The electroencephalogram in functional uterine bleeding: action of the estrogens by intravenous infusion  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese Em 10 pacientes do sexo feminino, portadoras de hemorragia uterina disfuncional, foi investigada a existência de manifestações epilépticas (clínicas e eletrencefalográficas) : dos 10 casos, 7 apresentavam antecedentes e/ou sintomas de natureza provável ou certamente epilépticos: o eletrencefalograma [...] foi anormal em 5 casos. Foi estudada a ação do Premarin por via intravenosa, na dose de 20 mg, durante registro eletrencefalográfico. Não houve piora do traçado durante ou após a injeção. Abstract in english In 10 patients with functional uterine bleeding, the existence of epileptic manifestations (clinical and electroencephalographic) was investigated: 7 among the 10 cases had a previous history and/or symptoms of a nature that was probably Or certainly epileptic; the electroencephalogram showed abnorm [...] alities in 5 cases. The action of intravenous Premarin (20 mg) was studied during electroencephalogram recording. There was no change in the normal electroencephalogram and in the patological ones there was not an increase of the abnormalities.

C., De Guarnieri Netto; Luís Marques de, Assis; Laplace Pinto, Vallada.

168

Effect of Aggressive Early High-Dose Intravenous Amino Acid Infusion and Early Trophic Enteral Nutrition on Very Low Birth Weight Infants  

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Full Text Available Objective: Very-low-birth-weight (VLBW preterm infants are at risk of growth delay if they do not receive adequate nutritional support. This study evaluated the effect of aggressive early high-dose amino acid infusion plus early enteral trophic feeding on growth in VLBW infants within the first day of life. Study design: The effect of a high-dose 3 g amino acid (HAA/kg/d regimen beginning on the first day of life was compared with that of low-dose amino acid (LAA supplementation at a dose of 0.5 or 1.0 g/kg/d. The primary outcome measures were the days of regained birth weight and achieved full enteral feeding. Result: Compared with the 19 infants in the LAA group, the 17 infants in the HAA group achieved significantly earlier full enteral feeding (7.8 ± 3.6 vs. 15.2 ± 8.9, p = 0.003 and regained birth weight (13.3 ± 3.8 vs. 17.5 ± 7.9, p = 0.047. In addition, shorter parenteral nutrition time was achieved by HAA administration (p < 0.05. Total energy intake was greater during the first 7 days of life in the HAA group (85 ± 12 kcal/kg/d on day 7 than in the LAA group (60 ± 16 kcal/kg/d on day 7, p < 0.001. Other clinical parameters such as length of hospital stay and morbidity favored the use of HAA. Conclusion: Aggressive early simultaneous amino acid administration plus enteral feeding during the first few days of life for preterm infants was associated with improved weight gain and earlier full enteral feeding.

Man-Yau Ho

2012-11-01

169

Insulin release is glucose anomeric specific in the human.  

Science.gov (United States)

The alpha-glucose anomer produces a greater insulin release than beta-glucose in various animal models. These glucose anomers were dissolved rapidly and administered intravenously to human volunteers at a high dose (0.5 g/kg) over a 3-min period or a low dose (3.5 g) over a 20-s period. Blood samples were obtained at frequent time intervals for measurement of whole blood glucose (ferricyanide), plasma glucose (beta-glucose oxidase) and serum immunoreactive insulin. The high-dose infusion test showed no differences between the anomers of either blood glucose or serum insulin levels. However, at the lower dose, the alpha-glucose anomer stimulated a significantly greater insulin release than did beta-glucose. It is concluded that the alpha-glucose anomer stimulates a greater insulin release than the beta-glucose anomer in human subjects at low but not at high doses intravenously and that this response is not apparently related to approximations of the degree of mutarotation. These results suggest that a steric specific glucose receptor site exists on the beta-cell as a rapid insulin release trigger, although the alpha-anomer does not exclusively produce this stimulation. PMID:947950

Rossini, A A; Soeldner, J S

1976-04-01

170

Acute administration of unacylated ghrelin has no effect on Basal or stimulated insulin secretion in healthy humans.  

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Unacylated ghrelin (UAG) is the predominant ghrelin isoform in the circulation. Despite its inability to activate the classical ghrelin receptor, preclinical studies suggest that UAG may promote ?-cell function. We hypothesized that UAG would oppose the effects of acylated ghrelin (AG) on insulin secretion and glucose tolerance. AG (1 µg/kg/h), UAG (4 µg/kg/h), combined AG+UAG, or saline were infused to 17 healthy subjects (9 men and 8 women) on four occasions in randomized order. Ghrelin was infused for 30 min to achieve steady-state levels and continued through a 3-h intravenous glucose tolerance test. The acute insulin response to glucose (AIRg), insulin sensitivity index (SI), disposition index (DI), and intravenous glucose tolerance (kg) were compared for each subject during the four infusions. AG infusion raised fasting glucose levels but had no effect on fasting plasma insulin. Compared with the saline control, AG and AG+UAG both decreased AIRg, but UAG alone had no effect. SI did not differ among the treatments. AG, but not UAG, reduced DI and kg and increased plasma growth hormone. UAG did not alter growth hormone, cortisol, glucagon, or free fatty acid levels. UAG selectively decreased glucose and fructose consumption compared with the other treatments. In contrast to previous reports, acute administration of UAG does not have independent effects on glucose tolerance or ?-cell function and neither augments nor antagonizes the effects of AG. PMID:24550190

Tong, Jenny; Davis, Harold W; Summer, Suzanne; Benoit, Stephen C; Haque, Ahrar; Bidlingmaier, Martin; Tschöp, Matthias H; D'Alessio, David

2014-07-01

171

Direct effects of TNF-? on local fuel metabolism and cytokine levels in the placebo controlled bilaterally infused human leg; increased insulin sensitivity, increased net protein breakdown and increased IL-6 release  

DEFF Research Database (Denmark)

TNF-? has widespread metabolic actions. Systemic TNF-? administration, however, generates a complex hormonal and metabolic response. Our study was designed to test whether regional, placebo controlled TNF-? infusion directly affects insulin resistance and protein breakdown. We studied eight healthy volunteers once with bilateral femoral vein and artery catheters during a 3 h basal period and a 3 h hyperinsulinemic euglycemic clamp. One artery was perfused with saline and one with TNF-?. During the clamp TNF-? perfusion increased glucose arterio-venous differences (0.91±0.17 mmol/l vs. 0.74±0.15 mmol/l, p=0.012) and leg glucose uptake rates. Net phenylalanine release was increased by TNF-? perfusion with concomitant increases in appearance and disappearance rates. Free fatty acid kinetics were not affected by TNF-?, whereas IL-6 release increased. Insulin and protein signaling in muscle biopsies was not affected by TNF-?. TNF-? directly increased net muscle protein loss, which may contribute to cachexia and general protein loss during severe illness. The finding of increased insulin sensitivity, which could relate to IL-6, is of major clinical interest and may concurrently act to provide adequate tissue fuel supply and contribute to the occurrence of systemic hypoglycemia. This distinct metabolic feature places TNF-? among the rare insulin mimetics of human origin.

Bach, Ermina; Nielsen, Bent Roni RanghØj

2013-01-01

172

Intravenous labetalol in severe hypertension  

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1 Labetalol was administered by intravenous infusion or by the combination of intravenous bolus injection plus infusion to 15 patients with severe essential hypertension and to one with phaeochromocytoma. 2 With the infusion alone the reduction of arterial pressure was slow to develop and limited in degree, but with the combination of the bolus injection plus the infusion the reduction in pressure was more prompt, more pronounced and longer lasting. Apart from an uncomplicated syncopal attack in one patient, no serious side — effects were encountered. 3 Subsequent treatment with oral labetalol usually required the addition of a diuretic to control the blood pressure probably due to sodium and fluid retention during treatment with labetalol alone. PMID:7093106

Dal Palu, C.; Pessina, A. C.; Semplicini, A.; Hlede, M.; Morandin, F.; Palatini, P.; Sperti, G.; Rossi, G. P.

1982-01-01

173

Studies on insulin secretion and insulin resistance in non-insulin-dependent diabetes in young Indians  

International Nuclear Information System (INIS)

Patients with Non-insulin-dependent diabetes mellitus (NIDDM) have defects in insulin secretion and insulin action. In the discrete genetic syndrome of NIDDY (non-insulin-dependent diabetes in the young), the situation is less clear and these aspects is the subject of this thesis. This study included Indian pasients with three generation transmission of NIDDM via one parent. The insulin and C-peptide responses to oral and intravenous glucose in patients with NIDDY were studied. The insulin and glucose responses to non-glucose secretogogues glucagon, tolbutamide and arginine, in NIDDY were also investigated. The following aspects with regard to insulin resistance in NIDDY were examined: glucose and free fatty acid response to intravenous insulin administration, insulin binding to circulating erythrocytes and monocytes, 125I-insulin binding to the solubilized erythrocyte membrane receptor and 125I-insulin binding to fibroblasts in culture

174

The relative contribution of insulin secretory capacity, insulin action, and incretins to metabolic control after islet transplantation in dogs.  

Science.gov (United States)

Adequate metabolic control is central to the concept of islet transplantation, but has received limited attention. We studied metabolic control in 8 dogs at 6-9 months after intrasplenic autografting of approximately 25% of the normal mass islets--as compared to 30 controls. A similar posttransplant reduction to approximately 25% of the insulin secretory capacity as assessed by intravenous arginine stimulation during 35 mM glucose clamps, mirrored the reduction of the islet mass. Postprandially, in contrast, the insulin response had increased to 140% in the islet recipients--with a concomitant rise of glycemia to approximately 8.5 mM. Posttransplant, the insulin secretory capacity correlated both with the index of insulin action (which averaged 55% of the normal value) as assessed by euglycemic hyperinsulinemic clamps, and--inverse--with the postprandial glucose excursions. Because insulin action did not correlate with postprandial glucose, the insulin secretory capacity appears to be the primary determinant of the impaired glucose tolerance. Marked postprandial hyperglucagonemia, and a virtually absent pancreatic polypeptide response in the grafted animals, may also have contributed to the impaired glucose tolerance. Posttransplant, infusion of a physiological dose of the gut hormone glucagon-like peptide-1 during 8.5 mM glucose clamps--mimicking the postprandial glycemia--potentiated glucose-stimulated insulin 175%. Thus, after transplantation of a suboptimal islet mass, postprandial glucose excursions are restrained by hyperglycemic potentiation of the entero-insular axis, which may account for the difference in the insulin response to the intravenous and oral challenges. Because, the insulin secretory capacity reflects the islet mass and appears to be the major determinant of glucoregulation, transplantation of a larger islet mass may allow near-normal glycemic control. PMID:9930939

van der Burg, M P; van Suylichem, P T; Guicherit, O R; Frölich, M; Lemkes, H H; Gooszen, H G

1999-01-01

175

Effects of atropine and gastric inhibitory polypeptide on hepatic glucose uptake and insulin extraction in conscious dogs.  

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Previous studies comparing the effects of oral, intraportal, and peripheral venous administration of glucose in conscious dogs demonstrated a significant increase in hepatic extraction of insulin only after oral glucose, but similar hepatic uptake of glucose after oral and intraportal glucose, which was greater than that after peripheral intravenous glucose infusion. This study evaluated the effect of atropine blockade of the parasympathetic nervous system on the increased fractional hepatic ...

Chap, Z.; Ishida, T.; Chou, J.; Lewis, R.; Hartley, C.; Entman, M.; Field, J. B.

1985-01-01

176

Anestesia venosa total em regime de infusão alvo-controlada: uma análise evolutiva Anestesia venosa total en régimen de infusión objeto controlada: un análisis evolutivo Total intravenous anesthesia as a target-controlled infusion: an evolutive analysis  

Directory of Open Access Journals (Sweden)

Full Text Available JUSTIFICATIVA E OBJETIVOS: A anestesia venosa total (AVT sofreu diversos avanços desde o início da utilização da técnica. Desde a síntese dos primeiros anestésicos venosos, com a introdução dos barbitúricos (1921 e do tiopental (1934, a AVT evoluiu até o desenvolvimento da AVT com auxílio de bombas com infusão alvo-controlada (IAC. O primeiro modelo farmacocinético para uso em IAC foi descrito por Schwilden em 1981. Foi demonstrado, a partir daí, que era possível manter a concentração plasmática desejada de um fármaco utilizando-se bomba de infusão gerenciada por computador. CONTEÚDO: Este artigo visou a descrever as bases teóricas da IAC, a apresentar uma proposta de desenvolvimento de um vocabulário comum em IAC ainda não publicado no Brasil e a fazer uma análise crítica dos aspectos atuais da IAC no mundo e no Brasil. CONCLUSÕES: A chegada de novas bombas de infusão dotadas dos modelos farmacocinéticos do remifentanil, sufentanil e propofol inaugura outro capítulo da AVT e alinha o Brasil com a tendência mundial em IAC. Esses sistemas possibilitarão a IAC de hipnóticos e opióides concomitantemente. A conclusão mais importante, no entanto, refere-se à economia à medida que os fármacos utilizados nessas bombas não ficarão restritos apenas a uma empresa farmacêutica, a exemplo do que ocorreu com o propofol. Hoje já se dispõe de equipamentos para utilização de propofol e opióides, em IAC, que aceitam qualquer apresentação farmacêutica com a vantagem da possibilidade de alteração da concentração do fármaco na seringa, de acordo com a diluição desejada.JUSTIFICATIVA Y OBJETIVOS: La anestesia venosa total (AVT tuvo diversos avances desde el inicio de la utilización de la técnica. Desde la síntesis de los primeros anestésicos venosos, con la introducción de los barbitúricos (1921 y del tiopental (1934, la AVT evolucionó hasta el desarrollo de la AVT con el auxilio de bombas con infusión objeto controlada (IOC. El primer modelo farmacocinético descrito para uso en IOC, fue descrito por Schwilden en 1981. Quedó demostrado a partir de entonces, que era posible mantener la concentración plasmática deseada de un fármaco utilizando bomba de infusión por computador. CONTENIDO: Este artigo quiso dejar sentadas las bases teóricas de la IOC, presentar una propuesta de desarrollo de un vocabulario común en IOC todavía no publicado en Brasil y hacer un análisis crítico de los aspectos actuales de la IOC en el mundo y en Brasil. CONCLUSIONES: La llegada de nuevas bombas de infusión dotadas de los modelos farmacocinéticos del remifentanil, sufentanil y propofol inaugura otro capítulo de la AVT y coloca a Brasil a tono con la tendencia mundial en IOC. Esos sistemas facilitarán la IOC de hipnóticos y opioides concomitantemente. La conclusión más importante, sin embargo, se refiere a la economía en la medida en que los fármacos utilizados en esas bombas no quedarán restrictos a solamente una empresa farmacéutica, como por ejemplo lo que ocurrió con el propofol. Hoy ya disponemos de equipos para la utilización de propofol y opioides en IOC, que aceptan cualquier presentación farmacéutica con la ventaja de poder alterar la concentración del fármaco en la jeringuilla de acuerdo con la dilución que se desee.BACKGROUND AND DOBJECTIVES: Total intravenous anesthesia (TIVA has seen several developments since it was first used. Since the synthesis of the first intravenous anesthetics, with the introduction of barbiturates (1921 and thiopental (1934, TIVA has evolved until the development of TIVA with target-controlled infusion pumps (TCI. The first pharmacokinetic model for the use of TCI was described by Schwilden in 1981. From that moment on, it was demonstrated that it is possible to maintain the desired plasma concentration of a drug using an infusion pump managed by a computer. CONTENTS: The objective of this report was to describe the theoretical bases of TCI, propose the development of a common TCI vocabulary, which has not been don

Fernando Squeff Nora

2008-04-01

177

Anestesia venosa total em regime de infusão alvo-controlada: uma análise evolutiva / Total intravenous anesthesia as a target-controlled infusion: an evolutive analysis / Anestesia venosa total en régimen de infusión objeto controlada: un análisis evolutivo  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese JUSTIFICATIVA E OBJETIVOS: A anestesia venosa total (AVT) sofreu diversos avanços desde o início da utilização da técnica. Desde a síntese dos primeiros anestésicos venosos, com a introdução dos barbitúricos (1921) e do tiopental (1934), a AVT evoluiu até o desenvolvimento da AVT com auxílio de bomb [...] as com infusão alvo-controlada (IAC). O primeiro modelo farmacocinético para uso em IAC foi descrito por Schwilden em 1981. Foi demonstrado, a partir daí, que era possível manter a concentração plasmática desejada de um fármaco utilizando-se bomba de infusão gerenciada por computador. CONTEÚDO: Este artigo visou a descrever as bases teóricas da IAC, a apresentar uma proposta de desenvolvimento de um vocabulário comum em IAC ainda não publicado no Brasil e a fazer uma análise crítica dos aspectos atuais da IAC no mundo e no Brasil. CONCLUSÕES: A chegada de novas bombas de infusão dotadas dos modelos farmacocinéticos do remifentanil, sufentanil e propofol inaugura outro capítulo da AVT e alinha o Brasil com a tendência mundial em IAC. Esses sistemas possibilitarão a IAC de hipnóticos e opióides concomitantemente. A conclusão mais importante, no entanto, refere-se à economia à medida que os fármacos utilizados nessas bombas não ficarão restritos apenas a uma empresa farmacêutica, a exemplo do que ocorreu com o propofol. Hoje já se dispõe de equipamentos para utilização de propofol e opióides, em IAC, que aceitam qualquer apresentação farmacêutica com a vantagem da possibilidade de alteração da concentração do fármaco na seringa, de acordo com a diluição desejada. Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: La anestesia venosa total (AVT) tuvo diversos avances desde el inicio de la utilización de la técnica. Desde la síntesis de los primeros anestésicos venosos, con la introducción de los barbitúricos (1921) y del tiopental (1934), la AVT evolucionó hasta el desarrollo de la [...] AVT con el auxilio de bombas con infusión objeto controlada (IOC). El primer modelo farmacocinético descrito para uso en IOC, fue descrito por Schwilden en 1981. Quedó demostrado a partir de entonces, que era posible mantener la concentración plasmática deseada de un fármaco utilizando bomba de infusión por computador. CONTENIDO: Este artigo quiso dejar sentadas las bases teóricas de la IOC, presentar una propuesta de desarrollo de un vocabulario común en IOC todavía no publicado en Brasil y hacer un análisis crítico de los aspectos actuales de la IOC en el mundo y en Brasil. CONCLUSIONES: La llegada de nuevas bombas de infusión dotadas de los modelos farmacocinéticos del remifentanil, sufentanil y propofol inaugura otro capítulo de la AVT y coloca a Brasil a tono con la tendencia mundial en IOC. Esos sistemas facilitarán la IOC de hipnóticos y opioides concomitantemente. La conclusión más importante, sin embargo, se refiere a la economía en la medida en que los fármacos utilizados en esas bombas no quedarán restrictos a solamente una empresa farmacéutica, como por ejemplo lo que ocurrió con el propofol. Hoy ya disponemos de equipos para la utilización de propofol y opioides en IOC, que aceptan cualquier presentación farmacéutica con la ventaja de poder alterar la concentración del fármaco en la jeringuilla de acuerdo con la dilución que se desee. Abstract in english BACKGROUND AND DOBJECTIVES: Total intravenous anesthesia (TIVA) has seen several developments since it was first used. Since the synthesis of the first intravenous anesthetics, with the introduction of barbiturates (1921) and thiopental (1934), TIVA has evolved until the development of TIVA with tar [...] get-controlled infusion pumps (TCI). The first pharmacokinetic model for the use of TCI was described by Schwilden in 1981. From that moment on, it was demonstrated that it is possible to maintain the desired plasma concentration of a drug using an infusion pump managed by a computer. CONTENTS: The objective o

Fernando Squeff, Nora.

178

Remifentanil infusion prolongs spinal anesthesia.  

Science.gov (United States)

Spinal anesthesia was given to a patient undergoing transurethral resection ofprostate (TURP). A total of 3.2 ml of bupivacaine 0.5% mixed with fentanyl 20 mcg were used. The patient started experiencing sensation after 150 min. Remifentanil intravenous infusion prolonged the duration of anesthesia for an additional 105 minutes. PMID:23833858

Soliman, Mohamed Hassan; Ibrahim, Sami M; Saeed, Kiran; El-Omrani, Hani; Kokach, Ousama

2013-02-01

179

Symptomatic cerebral oedema during treatment of diabetic ketoacidosis: effect of adjuvant octreotide infusion  

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Full Text Available Abstract Introduction A potentially lethal complication of diabetic ketoacidosis (DKA in children is brain oedema, whether caused by DKA itself or by the therapeutic infusion of insulin and fluids. Case presentation A 10-year old previously healthy boy with DKA became unconscious and apnoeic due to cerebral oedema (confirmed by abnormal EEG and CT-scan during treatment with intravenous fluids (36 ml/h and insulin (0.1 units/kg/h. He was intubated and artificially ventilated, without impact on EEG and CT-scan. Subsequently, adjuvant infusion of octreotide was applied (3.5 ?g/kg/h, suppressing growth hormone (GH and IGF-1 production and necessitating the insulin dose to be reduced to 0.05 - 0.025 units/kg/h. The brain oedema improved and the boy made a full recovery. Conclusion Co-therapy with octreotide was associated with a favourable outcome in the present patient with DKA and cerebral oedema. Whether this could be ascribed to the effects of octreotide on the insulin requirement or on the GH/IGF-axis remains to be elucidated.

Seewi Ora

2010-08-01

180

Comparison of glucose-insulin-thallium-201 infusion single photon emission computed tomography (SPECT), stress-redistribution-reinjection thallium-201 SPECT and low dose dobutamine echocardiography for prediction of reversible dysfunction  

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The usefulness of glucose-insulin-thallium-201 (GI-Tl) infusion single photon emission computed tomography (SPECT) in predicting reversible dysfunction has not been evaluated, so the present study recruited 20 patients with regional ischemic dysfunction for investigation. All patients underwent GI-Tl SPECT, post-stress Tl reinjection imaging and low dose dobutamine echocardiography. The diagnostic accuracy of these 3 techniques in predicting functional recovery was evaluated by receiver operating characteristic (ROC) analysis. In segments with functional recovery, regional Tl activities of GI-Tl SPECT were significantly higher than those of reinjection imaging (p<0.05), although there were no significant differences in segments without recovery. The area under the ROC curve for GI-Tl SPECT (0.75{+-}0.06) was greater than that for reinjection imaging (0.68{+-}0.07). The optimal cutoff values to identify viable myocardium were considered to be 55% of peak activity for GI-Tl SPECT and 50% for reinjection imaging. At this cutoff point, the sensitivity and specificity for detection of functional recovery were, respectively, 85% and 61% for GI-Tl SPECT, and 73% and 61% for reinjection imaging. Dobutamine echocardiography had the same sensitivity (85%), but lower specificity (48%) than GI-Tl SPECT. Continuous infusion of GI-Tl solution enhances regional Tl uptake compared with conventional post-stress reinjection imaging. This study suggests that GI-Tl SPECT is superior to reinjection imaging and dobutamine echocardiography in predicting functional recovery after ischemic left ventricular dysfunction. (author)

Sakamoto, Hiroki; Kondo, Makoto; Motohiro, Masayuki; Usami, Satoru [Shimada Municipal Hospital, Shizuoka (Japan)

2001-12-01

 
 
 
 
181

Glucose Infusion into Exercising Dogs after Confinement: Rectal and Active Muscle Temperatures  

Science.gov (United States)

Intravenous glucose infusion into ambulatory dogs results in attenuation of exercise-induced increase of both rectal and thigh muscle temperatures. That glucose (Glu) infusion attenuates excessive increase in body temperature from restricted activity during confinement deconditioning. Intravenous glucose infusion attenuates the rise in exercise core temperature in deconditioned dogs by a yet undefined mechanism.

Greenleaf, J. E.; Kruk, B.; Nazar, K.; Falecka-Wieczorek, I.; Kaciuba-Uscilko, H.

1995-01-01

182

Role of hepatic STAT3 in brain-insulin action on hepatic glucose production.  

Science.gov (United States)

STAT3 regulates glucose homeostasis by suppressing the expression of gluconeogenic genes in the liver. The mechanism by which hepatic STAT3 is regulated by nutritional or hormonal status has remained unknown, however. Here, we show that an increase in the plasma insulin concentration, achieved either by glucose administration or by intravenous insulin infusion, stimulates tyrosine phosphorylation of STAT3 in the liver. This effect of insulin was mediated by the hormone's effects in the brain, and the increase in hepatic IL-6 induced by the brain-insulin action is essential for the activation of STAT3. The inhibition of hepatic glucose production and of expression of gluconeogenic genes induced by intracerebral ventricular insulin infusion was impaired in mice with liver-specific STAT3 deficiency or in mice with IL-6 deficiency. These results thus indicate that IL-6-STAT3 signaling in the liver contributes to insulin action in the brain, leading to the suppression of hepatic glucose production. PMID:16581004

Inoue, Hiroshi; Ogawa, Wataru; Asakawa, Akihiro; Okamoto, Yasuo; Nishizawa, Akihiko; Matsumoto, Michihiro; Teshigawara, Kiyoshi; Matsuki, Yasushi; Watanabe, Eijiro; Hiramatsu, Ryuji; Notohara, Kenji; Katayose, Koji; Okamura, Hitoshi; Kahn, C Ronald; Noda, Tetsuo; Takeda, Kiyoshi; Akira, Shizuo; Inui, Akio; Kasuga, Masato

2006-04-01

183

Control of hepatic glycogen metabolism in the rhesus monkey: effect of glucose, insulin, and glucagon administration.  

Science.gov (United States)

The effects of intravenous glucose, insulin and glucagon admininistration on the hepatic glycogen synthase and glycogen phosphorylase systems were assessed in the anesthetized rhesus monkey. Results were correlated with measurements of hepatic cyclic AMP (cAMP) concentrations and plasma glucose, insulin, and glucagon concentrations. Both glucose and insulin administration promoted significant inactivation of phosphorylase by 1 min, which was followed by more gradual activation of synthase. Neither glucose nor insulin caused significant changes in hepatic cAMP. Marked hyperglucagonemia resulting from insulin-induced hypoglycemia did not cause increases IN in hepatic cAMP, suggesting that the elevated insulin levels possibly inhibited glucagon action on the hepatic adenylate cyclase-cAMP system. Glucagon administration caused large increases in hepatic cAMP and activation of phosphorylase within 1 min, followed by more gradual inactivation of synthase when it had been previously activated by glucose. Concomitant glucose infusion, with resulting increased plasma insulin concentrations, markedly diminished the duration of hepatic cAMP elevations following glucagon adminstration, again suggesting an insulin inhibition of glucagon action on the hepatic adenylate-cAMP system. PMID:167592

Curnow, R T; Rayfield, E J; George, D T; Zenser, T V; De Rubertis, F

1975-01-01

184

An audit of hospital based outpatient infusions and a pilot program of community-based monoclonal antibody infusions.  

LENUS (Irish Health Repository)

INTRODUCTION: Infliximab, a chimeric monoclonal antibody to tumour necrosis factor alpha, is administered as an intravenous infusion requiring a costly hospital day case or inpatient admission. METHODS: An audit of all current therapies given by intravenous infusions in an outpatient setting in St Vincent\\'s University Hospital (SVUH) was undertaken. Furthermore, in conjunction with TCP homecare, we established in a general practise health clinic, the first Irish community infusion centre for the administration of infliximab in August 2006. RESULTS: All outpatient departments indicated that they would favour a centralized hospital infusion unit. There were no adverse events and the mean global satisfaction improved in the community infliximab infusion pilot programme of seven patients. CONCLUSION: This study suggests efficiencies in providing centralized infusion facilities, while the community based infusion of infliximab is feasible and safe in this small cohort and identifies the community infusion unit as a viable and cost efficient alternative for administration of infliximab.

Doran, J-P

2012-02-01

185

Diagnosis of coronary artery disease by thallium-201 myocardial scintigraphy with intravenous infusion of SUNY4001 (adenosine) in effort angina pectoris. The clinical trial report at multi-center. Phase II  

International Nuclear Information System (INIS)

Forty-four patients with effort angina pectoris were evaluated with SUNY4001 (adenosine) thallium-201 (201Tl) myocardial scintigraphy to detect coronary artery disease. These patients had single-vessel disease (?American Heart Association (AHA) 90% stenosis) in either right coronary artery (RCA) or left anterior descending (LAD). Adenosine was infused at the rate of 120 or 140 ?g/kg/min for six minutes. One hundred eleven MBq of 201Tl was injected after three minutes of the start of the infusion. The early and delayed images were obtained by SPECT imaging. The sensitivity was 94.7% at 120 ?g/kg/min and 84.2% at 140 ?g/kg/min. Adenosine 201Tl myocardial scintigraphy showed high accuracy for detecting significant coronary artery disease. Adverse reactions occurred in 77.3% of the patients. Regarding the rates of the adverse reactions, there was no significant difference between 120 and 140 ?g/kg/min. Major adverse reactions were Chest pain/discomfort (52.3%) and Flushing/Feeling of warmth (27.3%). No serious complication was observed at any infusion rate. Most of adverse reactions disappeared shortly. Only two patients required treatment for moderate chest pain, which, however, disappeared in several minutes. One of the treatments was merely the termination of adenosine infusion, and the other was sublingual spray of nitroglycerin. Adenosine infusion caused slight decrease in blood pressure and increase in heart rate. The hemodynamic changes resolved within several minutes after the adenosine infusion. Decrease in systolic blood pressure of more than 20 mmHg from the base level occurred in 26.1% and 52.4% at 120 and 140 ?g/kg/min infusion rate respectively. Therefore, the adenosine infusion at 120 ?g/kg/min should be considered safe and useful for the diagnosis of coronary artery disease by pharmacologic stress imaging. (author)

186

Warmed intravenous infusion for controlling intraoperative hypothermia / Infusión venosa calentada en el control de la hipotermia durante el período intraoperatorio / Infusão venosa aquecida no controle da hipotermia no período intraoperatório  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese OBJETIVO: verificar a eficácia da intervenção de infusão venosa aquecida, na prevenção da hipotermia em pacientes no período intraoperatório. MÉTODO: estudo experimental, comparativo, de campo, prospectivo e quantitativo, realizado em um hospital público federal. A [...] amostra foi constituída por 60 adultos, que tiveram, como um dos critérios de inclusão, a temperatura axilar entre 36 e 37,1ºC e acesso cirúrgico abdominal, divididos em grupos controle e experimental, compostos utilizando-se a técnica de amostragem probabilística sistemática. RESULTADOS: nos 2 grupos, 22 pacientes (73,4%) saíram da sala de operação com hipotermia, ou seja, temperatura inferior a 36ºC (p=1,0000). A temperatura da sala de operação na entrada do paciente e a temperatura do paciente na entrada da sala de operação foram estatisticamente significativas para influenciar a ocorrência de hipotermia. CONCLUSÃO: o planejamento e implementação das intervenções de enfermagem, realizadas pelo enfermeiro, são essenciais para prevenção da hipotermia e manutenção da normotermia perioperatória. Abstract in spanish OBJETIVO: verificar la eficacia de la intervención de infusión venosa calentada en la prevención de la hipotermia en pacientes en el período intraoperatorio. MÉTODO: estudio experimental, comparativo, de campo, prospectivo y cuantitativo, en un hospital público fed [...] eral. La muestra abarcó a 60 adultos, que tuvieron como uno de los criterios de inclusión la temperatura axilar entre 36ºC y 37,1ºC y acceso quirúrgico abdominal, divididos en grupos control y experimental, compuestos utilizándose la técnica de muestreo probabilístico sistemático. RESULTADOS: en los 2 grupos, 22 pacientes (73,4%) salieron del quirófano con hipotermia, o sea, temperatura inferior a 36ºC (p=1,0000). La temperatura del quirófano cuando de la entrada del paciente y la temperatura del paciente cuando de la entrada en el quirófano fueron estadísticamente significativas para influir en la ocurrencia de hipotermia. CONCLUSÍON: la planificación e implementación de las intervenciones de enfermería practicadas por el enfermero son esenciales para prevenir la hipotermia y mantener la normotermia perioperatoria. Abstract in english OBJECTIVE: to verify the effectiveness of warmed intravenous infusion for hypothermia prevention in patients during the intraoperative period. METHOD: experimental, comparative, field, prospective and quantitative study undertaken at a federal public hospital. The [...] sample was composed of 60 adults, included based on the criteria of axillary temperature between 36ºC and 37.1ºC and surgical abdominal access, divided into control and experimental groups, using the systematic probability sampling technique. RESULTS: 22 patients (73.4%) from both groups left the operating room with hypothermia, that is, with temperatures below 36ºC (p=1.0000). The operating room temperature when patients arrived and patients' temperature when they arrived at the operating room were statistically significant to affect the occurrence of hypothermia. CONCLUSION: the planning and implementation of nursing interventions carried out by baccalaureate nurses are essential for preventing hypothermia and maintaining perioperative normothermia.

Ana Lúcia De, Mattia; Maria Helena, Barbosa; João Paulo Aché de, Freitas Filho; Adelaide De Mattia, Rocha; Nathália Haib Costa, Pereira.

2013-06-01

187

The diagnostic value for ischemic heart disease of thallium-201 myocardial scintigraphy by intravenous infusion of SUNY4001 (adenosine). The report of clinical trial at multi-center. Phase III  

International Nuclear Information System (INIS)

With two hundreds and seven patients unable to exercise adequately, the diagnostic accuracy and adverse reaction of 201Tl myocardial scintigraphy with the pharmacologic stress by SUNY4001 (adenosine) infusion were studied. Adenosine was infused for six minutes at the rate of 120 ?g/kg/min, and then 201Tl was injected after three minutes from the start of infusion. The early and delayed images were obtained by SPECT imaging. According to angiography, ?American Heart Association (AHA) 90% stenosis was defined as significant. The sensitivity of detecting coronary artery disease was 87.1% and the specificity was 46.0%. Adverse reactions occurred in 66.7% of the patients, most of which disappeared shortly with no need for treatment. Major adverse reactions were chest pain/discomfort (30.4%), flushing/feeling of warmth (22.4%) and blood pressure decrease (17.4%). Adenosine infusion caused slight decrease in blood pressure and increase in heart rate. These hemodynamic changes were resolved within several minutes from the termination of adenosine infusion. We concluded that adenosine-201Tl imaging is safe and useful to detect coronary artery disease in patients unable to exercise adequately. (author)

188

Intravenous lidocaine has no impact on rocuronium-induced neuromuscular block. Randomised study  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Intravenous lidocaine is increasingly used in surgical patients. As it has neuromuscular blocking effects, we tested the impact of an intravenous lidocaine infusion on the time course of a rocuronium-induced neuromuscular block.

Czarnetzki, C.; Lysakowski, Christopher; Elia, Nadia; Tramer, Martin

2012-01-01

189

Effect of IL-6 on the insulin sensitivity in patients with type 2 diabetes  

DEFF Research Database (Denmark)

Elevated interleukin-6 (IL-6) levels are associated with type 2 diabetes, but its role in glucose metabolism is controversial. We investigated the effect of IL-6 on insulin-stimulated glucose metabolism in type 2 diabetes patients and hypothesized that an acute, moderate IL-6 elevation would increase the insulin-mediated glucose uptake. Men with type 2 diabetes not treated with insulin [n = 9, age 54.9 ± 9.7 (mean ± SD) yr, body mass index 34.8 ± 6.1 kg/m(2), HbA1c 7.0 ± 1.0%] received continuous intravenous infusion with either recombinant human IL-6 (rhIL-6) or placebo. After 1 h with placebo or rhIL-6, a 3-h hyperinsulinemic-isoglycemic clamp was initiated. Whole body glucose metabolism was measured using stable isotope-labeled tracers. Signal transducer and activator of transcription 3 (STAT3) phosphorylation and suppressor of cytokine signaling 3 (SOCS3) expression were measured in muscle biopsies. Whole body energy expenditure was measured using indirect calorimetry. In response to the infusion of rhIL-6, circulating levels of IL-6 (P < 0.001), neutrophils (P < 0.001), and cortisol (P < 0.001) increased while lymphocytes decreased (P < 0.01). However, IL-6 infusion did not change glucose infusion rate, rate of appearance, or rate of disappearance during the clamp. While IL-6 enhanced phosphorylation of STAT3 in skeletal muscle (P = 0.041), the expression of SOCS3 remained unchanged. Whole body oxygen uptake (P < 0.01) and expired carbon dioxide (P < 0.01) increased during rhIL-6 infusion. In summary, although IL-6 induced local and systemic responses, the insulin-stimulated glucose uptake was not affected. While different contributing factors may be involved, our results are in contrast to our hypothesis and previous findings in young, healthy men.

Harder-Lauridsen, N M; Krogh-Madsen, R

2014-01-01

190

Massive levemir (long-acting) insulin overdose: case report.  

Science.gov (United States)

A 52-year-old insulin-dependant diabetic man presented to the Emergency Department 2 hours after a deliberate massive overdose of 2100 units of long-acting Levemir insulin and a large quantity of whisky. On initial assessment, his GCS was 3/15 and his capillary blood sugar was 2.6?mmol/L. The patient was given a 50?ml bolus of 50% dextrose, followed by intravenous infusions of both 5% and 10% dextrose. Despite the continuous infusions, he experienced 4 symptomatic hypoglycaemic episodes in the first 12 hours after admission. These were managed with oral glucose, IM glucagon, and further dextrose boluses. Blood electrolytes and pH were monitored throughout. Insulin overdoses are relatively common and often occur with an excess of other drugs or alcohol which can enhance its action. Overdoses can result in persistent hypoglycaemia, liver enzyme derangement, electrolyte abnormalities, and neurological damage. Overall mortality is 2.7% with prognosis poorest in patients who are admitted with decreased Glasgow Coma scale (GCS) 12 hours after overdose. PMID:22924049

Oduru, Mamatha; Ahmad, Mahmood

2012-01-01

191

Molecular links between obesity and insulin resistance  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The hypothalamic regulation of body weight is modulated by peripheral signals like ghrelin and insulin. We found a direct interaction between these two peripheral signals. High insulin caused a decrease in ghrelin concentration. Insulin resistance, a risk factor of type 2 diabetes, is a common consequence of obesity. Insulin resistance has been associated with activated inflammatory processes. In humans, insulin resistance can be induced by lipid infusion. We found that pretreatment with ...

Mo?hlig, Matthias

2012-01-01

192

Immunoglobulin replacement treatment by rapid subcutaneous infusion  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Long term intravenous immunoglobulin (IVIG) infusion is an effective treatment for children with immunodeficiencies, but can be complicated by poor venous access, systemic adverse reactions, and the need for frequent hospital admission. Rapid subcutaneous immunoglobulin (SCIG) infusion has been found to be effective in adults with primary immunodeficiency. Twenty six children were treated with SCIG for a median period of two years (range six months to 3.5 years). Fifteen ...

Gaspar, J.; Gerritsen, B.; Jones, A.

1998-01-01

193

Continuous subcutaneous infusion of glucagon-like peptide 1 lowers plasma glucose and reduces appetite in type 2 diabetic patients.  

DEFF Research Database (Denmark)

OBJECTIVE: The gut hormone glucagon-like peptide 1 (GLP-1) has insulinotropic and anorectic effects during intravenous infusion and has been proposed as a new treatment for type 2 diabetes and obesity. The effect of a single subcutaneous injection is brief because of rapid degradation. We therefore sought to evaluate the effect of infusion of GLP-1 for 48 h in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: We infused GLP-1 (2.4 pmol.kg-1.min-1) or saline subcutaneously for 48 h in randomized order in six patients with type 2 diabetes to evaluate the effect on appetite during fixed energy intake and on plasma glucose, insulin, glucagon, postprandial lipidemia, blood pressure, heart rate, and basal metabolic rate. RESULTS: The infusion resulted in elevations of the plasma concentrations of intact GLP-1 similar to those observed after intravenous infusion of 1.2 pmol.kg-1.min-1, previously shown to lower blood glucose effectively in type 2 diabetic patients. Fasting plasma glucose (day 2) decreased from 14.1 +/- 0.9 (saline) to 12.2 +/- 0.7 mmol/l (GLP-1), P = 0.009, and 24-h mean plasma glucose decreased from 15.4 +/- 1.0 to 13.0 +/- 1.0 mmol/l, P = 0.0009. Fasting and total area under the curve for insulin and C-peptide levels were significantly higher during the GLP-1 administration, whereas glucagon levels were unchanged. Neither triglycerides nor free fatty acids were affected. GLP-1 administration decreased hunger and prospective food intake and increased satiety, whereas fullness was unaffected. No side effects during GLP-1 infusion were recorded except for a brief cutaneous reaction. Basal metabolic rate and heart rate did not change significantly during GLP-1 administration. Both systolic and diastolic blood pressure tended to be lower during the GLP-1 infusion. CONCLUSIONS: We conclude that 48-h continuous subcutaneous infusion of GLP-1 in type 2 diabetic patients 1) lowers fasting as well as meal-related plasma glucose, 2) reduces appetite, 3) has no gastrointestinal side effects, and 4) has no negative effect on blood pressure.

Toft-Nielsen, M B; Madsbad, Sten

1999-01-01

194

Studies on the distribution of radioactivity in the organism during constant intravenous infusion of tracer amino acids and on the calculation of the rate of tissue protein synthesis in rats  

International Nuclear Information System (INIS)

Male wistar rats (100 p body weight) were infused into the tail vein with 14C-leucine and 14C-lysine simultaneously for 0.5; 1.0; 2.0; 3.0; 4.5; 6.0 and 7.0 hours. At the end of the infusion the specific radioactivity was determined of the free leucine and lysine in the blood plasma, liver, M. gastrocnemius, small intestine, and colon as well as of the protein-bound leucine and lysine. In all the tissues tested the specific radioactivity of the free amino acids attained a plateau during the 6-hour and 7-hour infusions. The rate constants for the increase were calculated for each organ tested. The two amino acids used are suitable for calculating the fractional rate of protein synthesis in tissues. The values of the fractional rate of protein synthesis calculated on the basis of the 6-hour and 7-hour infusions were: 54+-7.7%/day for the liver, 9.4+-1.2%/day for the muscles, 89+-12.2%/day for the small intestine, and 42+-5.9%/day for the colon. The simultaneous application of two tracer amino acids is recommendable for estimating the precursor pool of the protein synthesis and the more accurate calculation of the rate of protein synthesis. (author)

195

Insulin Pumps  

Science.gov (United States)

... More Information Advantages of Using an Insulin Pump Disadvantages of Using an Insulin Pump Getting Started with ... Insulin Pumps Advantages of Using an Insulin Pump Disadvantages of Using an Insulin Pump How Do Insulin ...

196

Krypton 81m infusion studies. Chapter 18  

International Nuclear Information System (INIS)

A technique is described to give a continuous, constant-rate, intravascular infusion of 81Krsup(m). Modifications of earlier generators included production of sodium-free 81Rb, the use of a solution of commercial sterile isotonic non-ionic 5% dextrose-in-water as an eluant, the incorporation of a constant-rate infusion pump, and the miniaturization of the generator column and catheter system. Results are presented of studies of 81Krsup(m) distribution in dogs, using both intravenous and intra-arterial infusion. (author)

197

Reações infusionais imediatas a agentes imunobiológicos endovenosos no tratamento de doenças autoimunes: experiência de 2.126 procedimentos em um centro de infusão não oncológico / Immediate infusional reactions to intravenous immunobiological agents for the treatment of autoimmune diseases: experience of 2126 procedures in a non-oncologic infusion centre  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese Introdução: Com o crescimento do uso de drogas imunobiológicas (IBD) ampliamos o conhecimento sobre sua eficácia e segurança. Objetivo: Analisar as reações infusionais imediatas (RII) às IBD endovenosas - infliximabe (IFX), rituximabe (RTX), abatacepte (ABT) e tocilizumabe (TCZ) - no tratamento [...] de doenças autoimunes. Método: Avaliamos 2.126 infusões feitas no CID (Centro de Infusão) em 268 pacientes. A droga usada, a indicação clínica, o tempo de infusão e o uso de pré-medicação foram determinados pelo médico prescritor. Foram consideradas RII todas as intercorrências apresentadas durante a infusão e/ou período observacional de 30 minutos. A conduta adotada nas RII seguiu os protocolos do CID. Resultados: Em relação ao tipo de IBD, as infusões foram distribuídas em: IFX (1.584; 74,5%), TCZ (226; 10,63%), RTX (185; 8,7%) e ABT (131; 6,16%). As RII foram descritas em 87 procedimentos (4,09%): 77 no grupo IFX e 10 no grupo RTX. Não foram descritas RII nos grupos de ABT e TCZ. A maioria foi considerada leve (n = 5; 41,17%) ou moderada (n = 50; 58,81%) e não houve reações graves. Das infusões interrompidas, 79 (92,9%) foram reiniciadas e concluídas com êxito. Apenas seis (0,28%) não foram concluídas por causa das RII. Conclusão: Apesar da diferença entre o número de procedimentos por droga, trata-se de uma análise de "vida real", na qual a incidência de RII foi semelhante à descrita na literatura. A baixa incidência de RII corrobora os dados de segurança tanto de forma quantitativa como qualitativa e ressalta a importância do acompanhamento médico especializado durante a infusão. Abstract in english Introduction: With the increasing use of immunobiological drugs (IBD), the knowledge about their effectiveness and safety has increased. Objective: To analyze the immediate infusional reactions (IIR) to intravenous IBD: infliximab (IFX), rituximab (RTX), abatacept (ABT) and tocilizumab (TCZ) on [...] the treatment of autoimmune diseases. Method: 2126 infusions performed in the Infusion Centre - CID in 268 patients were analyzed. The used drug, its clinical indication, infusion time, and use of premedication were determined by the prescribing physician. All intercurrences presented during infusion and/or during a thirty minutes observation period were considered as IIR. The approach adopted in IIR followed the protocols of the Infusion Centre - CID. Results: Regarding the type of IBD, the infused drugs given were: IFX (1584, 74.5%), TCZ (226, 10.63%), RTX (185, 8.7%) and ABT (131, 6,16%). IIR were described in 87 procedures (9.4%): 77 - IFX group and 10 - RTX group. IIR were not described in ABT and TCZ groups. Most were considered as mild (n = 5; 41.17%) or moderate (n = 50, 58.81%) reactions; there were no serious reactions. Regarding to discontinue infusions, 79 (92.9%) were resumed and completed successfully. Only six (0.28% of infusions) were not completed because of IIR. Conclusion: Despite the differences between the number of procedures per drug, ours is a "real life" analysis, where the incidence of IIR was similar to that described in the literature. The low incidence of IIR corroborates the safety data, both quantitatively and qualitatively, and underscores the importance of specialized medical support during infusion.

Ingrid Bandeira, Moss; Monique Bandeira, Moss; Debora Silva dos, Reis; Reno Martins, Coelho.

2014-04-01

198

Reações infusionais imediatas a agentes imunobiológicos endovenosos no tratamento de doenças autoimunes: experiência de 2.126 procedimentos em um centro de infusão não oncológico / Immediate infusional reactions to intravenous immunobiological agents for the treatment of autoimmune diseases: experience of 2126 procedures in a non-oncologic infusion centre  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese Introdução: Com o crescimento do uso de drogas imunobiológicas (IBD) ampliamos o conhecimento sobre sua eficácia e segurança. Objetivo: Analisar as reações infusionais imediatas (RII) às IBD endovenosas - infliximabe (IFX), rituximabe (RTX), abatacepte (ABT) e tocilizumabe (TCZ) - no tratamento [...] de doenças autoimunes. Método: Avaliamos 2.126 infusões feitas no CID (Centro de Infusão) em 268 pacientes. A droga usada, a indicação clínica, o tempo de infusão e o uso de pré-medicação foram determinados pelo médico prescritor. Foram consideradas RII todas as intercorrências apresentadas durante a infusão e/ou período observacional de 30 minutos. A conduta adotada nas RII seguiu os protocolos do CID. Resultados: Em relação ao tipo de IBD, as infusões foram distribuídas em: IFX (1.584; 74,5%), TCZ (226; 10,63%), RTX (185; 8,7%) e ABT (131; 6,16%). As RII foram descritas em 87 procedimentos (4,09%): 77 no grupo IFX e 10 no grupo RTX. Não foram descritas RII nos grupos de ABT e TCZ. A maioria foi considerada leve (n = 5; 41,17%) ou moderada (n = 50; 58,81%) e não houve reações graves. Das infusões interrompidas, 79 (92,9%) foram reiniciadas e concluídas com êxito. Apenas seis (0,28%) não foram concluídas por causa das RII. Conclusão: Apesar da diferença entre o número de procedimentos por droga, trata-se de uma análise de "vida real", na qual a incidência de RII foi semelhante à descrita na literatura. A baixa incidência de RII corrobora os dados de segurança tanto de forma quantitativa como qualitativa e ressalta a importância do acompanhamento médico especializado durante a infusão. Abstract in english Introduction: With the increasing use of immunobiological drugs (IBD), the knowledge about their effectiveness and safety has increased. Objective: To analyze the immediate infusional reactions (IIR) to intravenous IBD: infliximab (IFX), rituximab (RTX), abatacept (ABT) and tocilizumab (TCZ) on [...] the treatment of autoimmune diseases. Method: 2126 infusions performed in the Infusion Centre - CID in 268 patients were analyzed. The used drug, its clinical indication, infusion time, and use of premedication were determined by the prescribing physician. All intercurrences presented during infusion and/or during a thirty minutes observation period were considered as IIR. The approach adopted in IIR followed the protocols of the Infusion Centre - CID. Results: Regarding the type of IBD, the infused drugs given were: IFX (1584, 74.5%), TCZ (226, 10.63%), RTX (185, 8.7%) and ABT (131, 6,16%). IIR were described in 87 procedures (9.4%): 77 - IFX group and 10 - RTX group. IIR were not described in ABT and TCZ groups. Most were considered as mild (n = 5; 41.17%) or moderate (n = 50, 58.81%) reactions; there were no serious reactions. Regarding to discontinue infusions, 79 (92.9%) were resumed and completed successfully. Only six (0.28% of infusions) were not completed because of IIR. Conclusion: Despite the differences between the number of procedures per drug, ours is a "real life" analysis, where the incidence of IIR was similar to that described in the literature. The low incidence of IIR corroborates the safety data, both quantitatively and qualitatively, and underscores the importance of specialized medical support during infusion.

Ingrid Bandeira, Moss; Monique Bandeira, Moss; Debora Silva dos, Reis; Reno Martins, Coelho.

199

Approach to the adult hospitalized patient on an insulin pump.  

Science.gov (United States)

Patients on continuous subcutaneous insulin infusion, or insulin pumps, are increasingly seen in hospitals. Inpatient providers need to have a working knowledge of insulin pumps to be able to decide, in conjunction with the patient whenever feasible, whether or not pump use is to be continued in the hospital, to assist patients in adjusting insulin doses via continuous subcutaneous insulin infusion, to transition patients to multiple daily subcutaneous insulin dosing as appropriate, and to prevent or manage problems that might arise from improper handling of the insulin pump. Clinical vignettes with key points and strategies for patient care are discussed in this article. PMID:24227761

Lansang, M Cecilia; Modic, Mary Beth; Sauvey, Rebecca; Lock, Patricia; Ross, Deborah; Combs, Pamela; Kennedy, Laurence

2013-12-01

200

In vivo characterization of insulin uptake by dog renal cortical epithelium  

International Nuclear Information System (INIS)

In vivo 125I-labeled insulin uptake by dog renal tubular epithelium was studied using the single-pass multiple indicator dilution (MID) method and analyzed by a computer-assisted model of transcapillary exchange and substrate-cell interaction. Anesthetized dogs received an intrarenal arterial bolus of multiple tracers: [3H]dextran greater than 70 kDa (plasma reference), [14C]inulin (extracellular reference), and 125I-insulin. Rapid serial sampling of the renal venous and urine outflows was performed. The renal venous outflow curves of 125I-insulin fell below [14C]inulin implying postglomerular extraction and antiluminal membrane (ALM) uptake. The fractional urine recovery of 125I-insulin was less than 0.03, indicating luminal tubular uptake of filtered hormone. After intravenous infusion of unlabeled insulin, repeat MID runs with tracer revealed saturable ALM uptake as evidenced by the 125I-insulin renal venous outflow curves approaching [14C]inulin. Luminal tubular uptake was unchanged and therefore unsaturable. The 125I-insulin renal venous data were studied using three mathematical models, incorporating postglomerular reversible binding, irreversible binding or transport. The best fit was obtained using the transport model. The modeling analysis is consistent with either uptake into a virtual epithelial membrane space (i.e., insulin never enters the cell but binds to or is distributed along the ALM) or insulin actually enters the intracellular compartment. In vivo uptake of 125I-insulin ALM is characterized by a Km of 15.44 nM

 
 
 
 
201

An adaptive plasma glucose controller based on a nonlinear insulin/glucose model.  

Science.gov (United States)

The design of plasma glucose controllers traditionally relies on linear approaches. The implementation of an appropriate nonlinear model of the insulin/glucose regulatory system into an adaptive controller should predict the insulin-dependent glucose removal more reliably and hence provide better control over a wide spectrum of insulin signals. A discretized form of the model leads to a two-step procedure. First, the measured plasma glucose levels associated with the exogenous glucose infusion rates are used in the estimation of the past removal rates which, in turn, can be expressed as a weighted sum of past insulin inputs and previous values of the removal rate. Parameters of the sum are adjusted on-line by a recursive method of estimation which features a prefiltering of data to account for a corrupting coloured process noise. The same equation is in turn used to predict the time course of the insulin-dependent fractional rate of glucose removal. The performance of the controller, tested in vivo in three pigs, is presented for various intravenous or subcutaneous rapid injections and staircase infusions of insulin. Plasma glucose is maintained at an average level of 99.9 +/- 8.7% of the target value (% set point +/- coefficient of variation). The controller reacts promptly to large and rapid variations in insulin action. Although control improves with the number of glucose measurements, the prediction of glucose removal allows for some flexibility in the monitoring of the plasma glucose. Sampling frequency varied from a 2 min interval during transient periods to 7 min as steady states were reached. PMID:8026845

Candas, B; Radziuk, J

1994-02-01

202

Rapid Self-infusion of Tap Water  

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Full Text Available Intravenous self-infusion of tap water has never been reported in the literature.  We present a 24-year-old healthy man who self-administered 2.5 L of tap water over 2 hours and developed acute illness including fever, change of mental status, acute hemolysis, low-grade disseminated intravascular coagulation, and acute kidney injury.  

Sanjay Chaudhary

2013-03-01

203

Rapid Self-infusion of Tap Water  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Intravenous self-infusion of tap water has never been reported in the literature.  We present a 24-year-old healthy man who self-administered 2.5 L of tap water over 2 hours and developed acute illness including fever, change of mental status, acute hemolysis, low-grade disseminated intravascular coagulation, and acute kidney injury.  

Sanjay Chaudhary; Kianoush Kashani; Williams, Amy W.; El-zoghby, Ziad M.; Albright, Robert C.; Qi Qian

2013-01-01

204

Infusion therapy.  

Science.gov (United States)

Strides made in the past several decades have greatly enhanced patients' quality of life particularly that of cancer patients, who often have to receive continuous infusion therapy. Research efforts that resulted in the development and use of the long-line central indwelling silicone elastomeric catheter, new methods for problem management, and the design and use of portable infusion pumps for administration of investigational and other chemotherapeutic agents have made it possible to deliver safe care to these patients on an ambulatory basis. These new programs made it imperative that patients who received such care would have audio, not just verbal and written information to assist them in carrying out procedures for these programs. Patient education programs, and particularly the ones at M. D. Anderson Cancer Center have produced many teaching and information aids. These programs are a credit to the pioneering spirit and trust of patients who came to M. D. Anderson in those early days. I can remember well when all of us were trying and working together on these programs. This spirit continues today. PMID:1823571

Hilkemeyer, R E

1991-01-01

205

Intensive Insulin Therapy in Surgical Patients with Type 2 Diabetes Mellitus  

Directory of Open Access Journals (Sweden)

Full Text Available The aim of the investigation was to assess the efficiency of intensive insulin therapy in surgical patients with type 2 diabetes mellitus (DM 2 in intensive care unit in relation to the effect on postoperative clinical progression and 90-day survival of patients. Materials and Methods. The study included 89 patients hospitalized in intensive care unit for various surgical pathologies, with DM 2 in past medical history. On admission the patients were divided into 4 groups in a random manner. First 72 h target glycemia range for groups 1 and 2 was glucose level of 6.5–8.5 mmol/L, and for groups 3 and 4 — 8.6–11.0 mmol/L. Continuous insulin infusion was chosen for the treatment of groups 1 and 3 for the same period, the patients of groups 2 and 4 were given divided insulin injections. The severity of all patients was studied first 24 h and 72 h after inpatient treatment according to APACHE II, SAPS II.Conclusion. In ICU patients suffering from type 2 DM with various surgical pathology, target glycemic levels of 6.5–8.5 and 8.6–11.0 within the frame of one insulin therapy method are not associated with the differences in relation to the severity and outcome of the main pathology. Glycemic control in target range of 6.5–11.0 mmol/L by intravenous insulin infusion has the advantage over divided insulin subcutaneous injections regarding the severity and outcome of the main pathology.

?.S. Komissarova

2013-03-01

206

Familiality of physical and metabolic characteristics that predict the development of non-insulin-dependent diabetes mellitus in Pima Indians  

Energy Technology Data Exchange (ETDEWEB)

Susceptibility to non-insulin-dependent diabetes mellitus (NIDDM) is largely genetically determined. In Pima Indians, obesity, insulin resistance, and a low acute insulin response (AIR) to an intravenous glucose infusion are each predictors of the disease. To ascertain whether these phenotypes are genetically determined, we estimated their familiarity in nondiabetic Pima Indians with a maximum-likelihood method. Percentage body fat (PFAT) was highly familial (h{sup 2} = .76), whereas waist/thigh circumference ratio (W/T ratio) was not significantly familial after controlling for PFAT (h{sup 2} = .16). AIR was also highly familial (h{sup 2} = .80 at 10 min), even after controlling for PFAT and insulin action (h{sup 2} = .70). Insulin action at physiologic plasma insulin concentrations was familial (h{sup 2} = .61) but less so after controlling for PFAT and W/T ratio (h{sup 2} = .38). At maximally stimulating insulin concentrations, insulin action was familial (h{sup 2} = .45) and was less influenced by controlling for PFAT and W/T ratio (h{sup 2} = .49). We conclude that in Pima Indians (1) PFAT and AIR are highly familial traits, (2) central distribution of fat is not a familial trait when controlled for PFAT, (3) 38%-49% of the variance in insulin action, independent of the effect of obesity, is familial, and (4) PFAT, AIR, and insulin action are useful traits to study genetic susceptibility to NIDDM. Because genetic parameter estimates are applicable only to the populations from which they were estimated, it is important to determine whether these estimates of familiarities in Pima Indians can be confirmed in other populations before the utility of these traits in searching for NIDDM susceptibility genes in those populations can be fully advocated. 31 refs., 3 tabs.

Sakul, H.; Cardon, L. [Sequana Therapeutics, Inc., La Jolla, CA (United States); Pratley, R. [National Inst. of Health, Phoenix, AZ (United States)] [and others

1997-03-01

207

Efeitos cardiorrespiratórios e analgésicos da cetamina por via epidural, por infusão intravenosa contínua ou pela associação de ambas, em cães submetidos à osteossíntese de fêmur / Cardiorespiratory and analgesic effects of ketamine via epidural route, intravenous continuous infusion or association of both, in dogs submitted to femoral osteosynthesis  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese A cetamina tem demonstrado efeito analgésico em doses subanestésicas, além da manutenção da estabilidade dos parâmetros fisiológicos. O estudo objetivou avaliar os efeitos cardiorrespiratórios e a analgesia pós-operatória da cetamina administrada por via epidural, por infusão intravenosa contínua ou [...] pela associação de ambas, em cães submetidos à osteossíntese de fêmur. Foram utilizadas 25 cadelas, hígidas, distribuídas aleatoriamente em quatro grupos: CEP (2mg kg-1 de cetamina associada à lidocaína 2% via epidural), CIV (lidocaína 2% via epidural e 1mg kg-1 de cetamina IV seguido de infusão contínua IV com 100µg kg min-1 da mesma), CIVEP (2mg kg-1 de cetamina associada à lidocaína 2% via epidural e 1mg kg-1 de cetamina IV, seguido de infusão contínua IV com 100µg kg min-1) e CON (anestesia epidural com lidocaína 2%). Avaliaram-se FC, f, PAS, PAM, PAD, T°C, tempo de bloqueio motor e analgesia pós-operatória por meio de escala analógica visual. Houve elevação da FC no CIV e diminuição desse parâmetro no CEP. As pressões arteriais mantiveram-se dentro dos valores fisiológicos e não foram observadas diferenças na f e T°C. O tempo de duração do bloqueio anestésico foi potencializado nos grupos que receberam cetamina epidural, diferindo significativamente em relação ao controle. O tempo para a analgesia resgate não diferiu entre os grupos. Conclui-se que a administração de cetamina pela via epidural, por infusão contínua intravenosa ou pela associação de ambas promoveu estabilidade cardiorrespiratória no período transcirúrgico, porém não foi capaz de prolongar a duração da analgesia pós-operatória em cães submetidos à osteossíntese de fêmur. Abstract in english Ketamine has demonstrated analgesic effects in subanesthetic doses, besides the maintenance of stability of physiological parameters. The study aimed to evaluate the cardiorespiratory effects and the post operative analgesia of ketamine via epidural route, intravenous continuous infusion or associat [...] ion of both, in dogs submitted to femoral osteosynthesis. Twenty-five healthy bitches were randomly assigned to four groups: CEP (2mg kg-1 of ketamine associated with lidocaine 2% via epidural route), CIV (lidocaine 2% via epidural route and 1mg kg-1 of ketamine IV, followed by IV continuous infusion of 100µg kg min-1 of ketamine), CIVEP (epidural anesthesia identical to CEP and ketamine infusion as in CIV) and CON (epidural anesthesia with lidocaine 2%). HR, RR, SAP, MAP, DAP and T°C, sensitive blockade time and post operative analgesia measured with visual analog scale were evaluated. There was an increase in HR in CIV and decrease of this parameter in CEP. Arterial pressures kept within physiological values and differences in RR and T°C were not observed. The anesthetic blockade time was augmented in the groups which received epidural ketamine, differing significantly in relation to the control. The time for rescue analgesia did not differ between the groups. It can be concluded the administration of ketamine via epidural route, intravenous continuous infusion or the association of both promoted cardiorespiratory stability during the operative period; however, it was not able to extend the duration of post operative analgesia in dogs submitted to femoral osteosynthesis.

Adriano Bonfim, Carregaro; Gabrielle Coelho, Freitas; Jenifer de Santana, Marques; Thomas Alexander, Trein; Virgínia Heinze, Pohl; Fabiano Zanini, Salbego; Alceu Gaspar, Raiser.

208

Efeitos cardiorrespiratórios e analgésicos da cetamina por via epidural, por infusão intravenosa contínua ou pela associação de ambas, em cães submetidos à osteossíntese de fêmur / Cardiorespiratory and analgesic effects of ketamine via epidural route, intravenous continuous infusion or association of both, in dogs submitted to femoral osteosynthesis  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese A cetamina tem demonstrado efeito analgésico em doses subanestésicas, além da manutenção da estabilidade dos parâmetros fisiológicos. O estudo objetivou avaliar os efeitos cardiorrespiratórios e a analgesia pós-operatória da cetamina administrada por via epidural, por infusão intravenosa contínua ou [...] pela associação de ambas, em cães submetidos à osteossíntese de fêmur. Foram utilizadas 25 cadelas, hígidas, distribuídas aleatoriamente em quatro grupos: CEP (2mg kg-1 de cetamina associada à lidocaína 2% via epidural), CIV (lidocaína 2% via epidural e 1mg kg-1 de cetamina IV seguido de infusão contínua IV com 100µg kg min-1 da mesma), CIVEP (2mg kg-1 de cetamina associada à lidocaína 2% via epidural e 1mg kg-1 de cetamina IV, seguido de infusão contínua IV com 100µg kg min-1) e CON (anestesia epidural com lidocaína 2%). Avaliaram-se FC, f, PAS, PAM, PAD, T°C, tempo de bloqueio motor e analgesia pós-operatória por meio de escala analógica visual. Houve elevação da FC no CIV e diminuição desse parâmetro no CEP. As pressões arteriais mantiveram-se dentro dos valores fisiológicos e não foram observadas diferenças na f e T°C. O tempo de duração do bloqueio anestésico foi potencializado nos grupos que receberam cetamina epidural, diferindo significativamente em relação ao controle. O tempo para a analgesia resgate não diferiu entre os grupos. Conclui-se que a administração de cetamina pela via epidural, por infusão contínua intravenosa ou pela associação de ambas promoveu estabilidade cardiorrespiratória no período transcirúrgico, porém não foi capaz de prolongar a duração da analgesia pós-operatória em cães submetidos à osteossíntese de fêmur. Abstract in english Ketamine has demonstrated analgesic effects in subanesthetic doses, besides the maintenance of stability of physiological parameters. The study aimed to evaluate the cardiorespiratory effects and the post operative analgesia of ketamine via epidural route, intravenous continuous infusion or associat [...] ion of both, in dogs submitted to femoral osteosynthesis. Twenty-five healthy bitches were randomly assigned to four groups: CEP (2mg kg-1 of ketamine associated with lidocaine 2% via epidural route), CIV (lidocaine 2% via epidural route and 1mg kg-1 of ketamine IV, followed by IV continuous infusion of 100µg kg min-1 of ketamine), CIVEP (epidural anesthesia identical to CEP and ketamine infusion as in CIV) and CON (epidural anesthesia with lidocaine 2%). HR, RR, SAP, MAP, DAP and T°C, sensitive blockade time and post operative analgesia measured with visual analog scale were evaluated. There was an increase in HR in CIV and decrease of this parameter in CEP. Arterial pressures kept within physiological values and differences in RR and T°C were not observed. The anesthetic blockade time was augmented in the groups which received epidural ketamine, differing significantly in relation to the control. The time for rescue analgesia did not differ between the groups. It can be concluded the administration of ketamine via epidural route, intravenous continuous infusion or the association of both promoted cardiorespiratory stability during the operative period; however, it was not able to extend the duration of post operative analgesia in dogs submitted to femoral osteosynthesis.

Adriano Bonfim, Carregaro; Gabrielle Coelho, Freitas; Jenifer de Santana, Marques; Thomas Alexander, Trein; Virgínia Heinze, Pohl; Fabiano Zanini, Salbego; Alceu Gaspar, Raiser.

1583-15-01

209

Efeitos cardiorrespiratórios e analgésicos da cetamina por via epidural, por infusão intravenosa contínua ou pela associação de ambas, em cães submetidos à osteossíntese de fêmur Cardiorespiratory and analgesic effects of ketamine via epidural route, intravenous continuous infusion or association of both, in dogs submitted to femoral osteosynthesis  

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Full Text Available A cetamina tem demonstrado efeito analgésico em doses subanestésicas, além da manutenção da estabilidade dos parâmetros fisiológicos. O estudo objetivou avaliar os efeitos cardiorrespiratórios e a analgesia pós-operatória da cetamina administrada por via epidural, por infusão intravenosa contínua ou pela associação de ambas, em cães submetidos à osteossíntese de fêmur. Foram utilizadas 25 cadelas, hígidas, distribuídas aleatoriamente em quatro grupos: CEP (2mg kg-1 de cetamina associada à lidocaína 2% via epidural, CIV (lidocaína 2% via epidural e 1mg kg-1 de cetamina IV seguido de infusão contínua IV com 100µg kg min-1 da mesma, CIVEP (2mg kg-1 de cetamina associada à lidocaína 2% via epidural e 1mg kg-1 de cetamina IV, seguido de infusão contínua IV com 100µg kg min-1 e CON (anestesia epidural com lidocaína 2%. Avaliaram-se FC, f, PAS, PAM, PAD, T°C, tempo de bloqueio motor e analgesia pós-operatória por meio de escala analógica visual. Houve elevação da FC no CIV e diminuição desse parâmetro no CEP. As pressões arteriais mantiveram-se dentro dos valores fisiológicos e não foram observadas diferenças na f e T°C. O tempo de duração do bloqueio anestésico foi potencializado nos grupos que receberam cetamina epidural, diferindo significativamente em relação ao controle. O tempo para a analgesia resgate não diferiu entre os grupos. Conclui-se que a administração de cetamina pela via epidural, por infusão contínua intravenosa ou pela associação de ambas promoveu estabilidade cardiorrespiratória no período transcirúrgico, porém não foi capaz de prolongar a duração da analgesia pós-operatória em cães submetidos à osteossíntese de fêmur.Ketamine has demonstrated analgesic effects in subanesthetic doses, besides the maintenance of stability of physiological parameters. The study aimed to evaluate the cardiorespiratory effects and the post operative analgesia of ketamine via epidural route, intravenous continuous infusion or association of both, in dogs submitted to femoral osteosynthesis. Twenty-five healthy bitches were randomly assigned to four groups: CEP (2mg kg-1 of ketamine associated with lidocaine 2% via epidural route, CIV (lidocaine 2% via epidural route and 1mg kg-1 of ketamine IV, followed by IV continuous infusion of 100µg kg min-1 of ketamine, CIVEP (epidural anesthesia identical to CEP and ketamine infusion as in CIV and CON (epidural anesthesia with lidocaine 2%. HR, RR, SAP, MAP, DAP and T°C, sensitive blockade time and post operative analgesia measured with visual analog scale were evaluated. There was an increase in HR in CIV and decrease of this parameter in CEP. Arterial pressures kept within physiological values and differences in RR and T°C were not observed. The anesthetic blockade time was augmented in the groups which received epidural ketamine, differing significantly in relation to the control. The time for rescue analgesia did not differ between the groups. It can be concluded the administration of ketamine via epidural route, intravenous continuous infusion or the association of both promoted cardiorespiratory stability during the operative period; however, it was not able to extend the duration of post operative analgesia in dogs submitted to femoral osteosynthesis.

Adriano Bonfim Carregaro

2010-07-01

210

Review of pharmacokinetic models for target controlled infusions in anesthesia  

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Full Text Available Intravenous injection of anesthetic drugs dates back to the 17th Century when opium and chloral hydrate have been injected intravenously. It was not until the 1930s intravenous anesthesia became popular with the invention of barbiturates.Early intravenous anesthetic agents such as barbiturates were ideal for induction of anesthesia, but not suitable for maintenance of anesthesia. Most of these drugs accumulated significantly with increasing durations of infusion and also resulted in cardiorespiratory depression. The invention of propofol and shorter acting opioid analgesics such as remifentanil and alfentanil have revolutionized intravenous anesthesia. The rapid onset and offset of these drugs lends itself to being suitable agents for maintenance of anesthesia over prolonged periods of time. Detailed understanding of the pharmacokinetics of propofol and remifentanil, combined with technological advances in intravenous pumps capable of accurate delivery of drugs have resulted in great development of the field of total intravenous anesthesia and target controlled infusions. I would like to discuss, in this article, the pharmacokinetics and pharmacokinetic models behind these intravenous infusion pumps. [Int J Basic Clin Pharmacol 2014; 3(3.000: 417-423

Subash Kennedy Sivasubramaniam

2014-06-01

211

Insulin Basics  

Science.gov (United States)

... Print Page Text Size: A A A Listen Insulin Basics There are different types of insulin depending ... you may be experiencing a reaction. Types of Insulin Rapid-acting insulin , begins to work about 15 ...

212

Monosodium glutamate (MSG)-obese rats develop glucose intolerance and insulin resistance to peripheral glucose uptake  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english Different levels of insulin sensitivity have been described in several animal models of obesity as well as in humans. Monosodium glutamate (MSG)-obese mice were considered not to be insulin resistant from data obtained in oral glucose tolerance tests. To reevaluate insulin resistance by the intraven [...] ous glucose tolerance test (IVGTT) and by the clamp technique, newborn male Wistar rats (N = 20) were injected 5 times, every other day, with 4 g/kg MSG (N = 10) or saline (control; N = 10) during the first 10 days of age. At 3 months, the IVGTT was performed by injecting glucose (0.75 g/kg) through the jugular vein into freely moving rats. During euglycemic clamping plasma insulin levels were increased by infusing 3 mU . kg-1 . min-1 of regular insulin until a steady-state plateau was achieved. The basal blood glucose concentration did not differ between the two experimental groups. After the glucose load, increased values of glycemia (P

A.E., Hirata; I.S., Andrade; P., Vaskevicius; M.S., Dolnikoff.

213

Monosodium glutamate (MSG)-obese rats develop glucose intolerance and insulin resistance to peripheral glucose uptake  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english Different levels of insulin sensitivity have been described in several animal models of obesity as well as in humans. Monosodium glutamate (MSG)-obese mice were considered not to be insulin resistant from data obtained in oral glucose tolerance tests. To reevaluate insulin resistance by the intraven [...] ous glucose tolerance test (IVGTT) and by the clamp technique, newborn male Wistar rats (N = 20) were injected 5 times, every other day, with 4 g/kg MSG (N = 10) or saline (control; N = 10) during the first 10 days of age. At 3 months, the IVGTT was performed by injecting glucose (0.75 g/kg) through the jugular vein into freely moving rats. During euglycemic clamping plasma insulin levels were increased by infusing 3 mU . kg-1 . min-1 of regular insulin until a steady-state plateau was achieved. The basal blood glucose concentration did not differ between the two experimental groups. After the glucose load, increased values of glycemia (P

A.E., Hirata; I.S., Andrade; P., Vaskevicius; M.S., Dolnikoff.

1997-05-01

214

Estabilidad de parecoxib en dilución con otros fármacos y administración en perfusión continua IV para el control del dolor postoperatorio / Stability of parecoxib in dilution with other drugs and administered in continuous intravenous infusion for the management of postoperative pain  

Scientific Electronic Library Online (English)

Full Text Available SciELO Spain | Language: Spanish Abstract in spanish Objetivo: Evaluar la estabilidad de parecoxib en un sistema de infusión continua elastomérica portátil IV para 24 horas, en dilución con opiáceos (cloruro mórfico, meperidina ó tramadol), antieméticos y suero fisiológico, durante las 24 horas del postoperatorio; así como, comprobar el resultado anal [...] gésico, la aparición de efectos secundarios y el grado de satisfacción de pacientes intervenidos de cirugía mayor susceptibles de tratamiento con dichos fármacos. Material y Métodos: El infusor es un dispositivo desechable y ligero con un depósito elastomérico para administrar medicación. Se realizaron varias pruebas mezclando parecoxib, opiáceos, antieméticos y suero fisiológico y se observó su estabilidad durante 24 horas. Procedimos a observar la mezcla en repetidas ocasiones y la dilución siempre permaneció estable, clara, sin partículas y transparente; por lo que se decidió utilizar dicha mezcla en el infusor IV para el tratamiento del dolor postoperatorio, siempre bajo la supervisión de un anestesiólogo. Se estudiaron un total de 118 pacientes, 46 mujeres (39%) y 72 hombres (61%), ASA I-IV, edad media 59,75 +/- 14,25 (18-89), 92 (78%) fueron intervenidos de cirugía general y 26 (22%) de urología. El llenado del infusor según ASA, edad y tipo de intervención del paciente, se realizó con: parecoxib 80 mg + metoclopramida Cl H 20 ó 30 mg + suero fisiológico en los 118 pacientes, se añadió cloruro mórfico en 65 pacientes, meperidina en 30 y tramadol en 23, a administrar en 24 horas tras la intervención quirúrgica. Se valoró la intensidad del dolor según EAV a la llegada a la Sala de Despertar y a las 24 horas, resultado analgésico, efectos secundarios y grado de satisfacción. Resultados: El resultado analgésico fue muy bueno en 60 pacientes (50,85%); bueno en 40 (33,90%); regular en 12 (10,17%) y suspendido el tratamiento en 6 (5%) por efectos secundarios. Los efectos secundarios aparecieron en 30 casos (25%): 4 con sudoración (3%), 1 con desorientación (0,8%) y 7 con somnolencia y mareo (6%) 3 de ellos con interrupción del tratamiento. En cuanto a las náuseas y/o vómitos: 18 pacientes necesitaron rescate antiemético, y en 3, hubo que suspender el tratamiento. El grado de satisfacción del paciente fue: muy satisfactorio en 56 pacientes (47,5%); satisfactorio en 46 (39%), deficiente en 10 (8,5%) y suspendido el tratamiento en 6 (5%) por efectos secundarios. Conclusiones: La posibilidad de utilizar parecoxib sólo o unido a otros fármacos en perfusión continua IV para el tratamiento del dolor agudo postoperatorio, es una opción a considerar. Abstract in english Objective: To evaluate the stability of parecoxib in a portable elasto-meric pump system for IV infusión in dilution with opioids (morphine chloride, pethidine or tramadol), antiemetics and saline solution during 24 hours in the postoperative period; as well as to verify the analgesic result, the in [...] cidence of side effects and the degree of satisfaction in patients undergoing major surgery that were eligible for treatment with these drugs. Material and Methods: The infuser pump is a light disposable device with an elas-tomeric deposit to administer the medication. Several tests combining parecoxib, opioids, antiemetics and saline solution were carried out and its stability was demonstrated during 24 hours. The mixture was then observed in several occasions and was shown that the dilution always remained stable, clear, with no particles and transparent; therefore it was decided to use that combination in the IV infuser for the treatment of postoperative pain, always under the anaesthesiologist supervisión. A total of 118 patients were studied, 46 women (39%) and 72 men studied (61%), ASA ITV, mean age 59.75 +/- 14.25 (18-89); 92 (78%) underwent general surgery procedures and 26 (22%) urologic ones. The filling of infuser according to ASA, age and type of surgery of the patient, was made with: parecoxib 80 mg + metoclopramide CL H

P., Acín; C., Bono; R., Martínez; A., Faci; E., Facorro; I., Manzanares; MªJ., Velamazán; Mª, Sanz; E., Pastor.

2007-04-01

215

Estabilidad de parecoxib en dilución con otros fármacos y administración en perfusión continua IV para el control del dolor postoperatorio Stability of parecoxib in dilution with other drugs and administered in continuous intravenous infusion for the management of postoperative pain  

Directory of Open Access Journals (Sweden)

Full Text Available Objetivo: Evaluar la estabilidad de parecoxib en un sistema de infusión continua elastomérica portátil IV para 24 horas, en dilución con opiáceos (cloruro mórfico, meperidina ó tramadol, antieméticos y suero fisiológico, durante las 24 horas del postoperatorio; así como, comprobar el resultado analgésico, la aparición de efectos secundarios y el grado de satisfacción de pacientes intervenidos de cirugía mayor susceptibles de tratamiento con dichos fármacos. Material y Métodos: El infusor es un dispositivo desechable y ligero con un depósito elastomérico para administrar medicación. Se realizaron varias pruebas mezclando parecoxib, opiáceos, antieméticos y suero fisiológico y se observó su estabilidad durante 24 horas. Procedimos a observar la mezcla en repetidas ocasiones y la dilución siempre permaneció estable, clara, sin partículas y transparente; por lo que se decidió utilizar dicha mezcla en el infusor IV para el tratamiento del dolor postoperatorio, siempre bajo la supervisión de un anestesiólogo. Se estudiaron un total de 118 pacientes, 46 mujeres (39% y 72 hombres (61%, ASA I-IV, edad media 59,75 +/- 14,25 (18-89, 92 (78% fueron intervenidos de cirugía general y 26 (22% de urología. El llenado del infusor según ASA, edad y tipo de intervención del paciente, se realizó con: parecoxib 80 mg + metoclopramida Cl H 20 ó 30 mg + suero fisiológico en los 118 pacientes, se añadió cloruro mórfico en 65 pacientes, meperidina en 30 y tramadol en 23, a administrar en 24 horas tras la intervención quirúrgica. Se valoró la intensidad del dolor según EAV a la llegada a la Sala de Despertar y a las 24 horas, resultado analgésico, efectos secundarios y grado de satisfacción. Resultados: El resultado analgésico fue muy bueno en 60 pacientes (50,85%; bueno en 40 (33,90%; regular en 12 (10,17% y suspendido el tratamiento en 6 (5% por efectos secundarios. Los efectos secundarios aparecieron en 30 casos (25%: 4 con sudoración (3%, 1 con desorientación (0,8% y 7 con somnolencia y mareo (6% 3 de ellos con interrupción del tratamiento. En cuanto a las náuseas y/o vómitos: 18 pacientes necesitaron rescate antiemético, y en 3, hubo que suspender el tratamiento. El grado de satisfacción del paciente fue: muy satisfactorio en 56 pacientes (47,5%; satisfactorio en 46 (39%, deficiente en 10 (8,5% y suspendido el tratamiento en 6 (5% por efectos secundarios. Conclusiones: La posibilidad de utilizar parecoxib sólo o unido a otros fármacos en perfusión continua IV para el tratamiento del dolor agudo postoperatorio, es una opción a considerar.Objective: To evaluate the stability of parecoxib in a portable elasto-meric pump system for IV infusión in dilution with opioids (morphine chloride, pethidine or tramadol, antiemetics and saline solution during 24 hours in the postoperative period; as well as to verify the analgesic result, the incidence of side effects and the degree of satisfaction in patients undergoing major surgery that were eligible for treatment with these drugs. Material and Methods: The infuser pump is a light disposable device with an elas-tomeric deposit to administer the medication. Several tests combining parecoxib, opioids, antiemetics and saline solution were carried out and its stability was demonstrated during 24 hours. The mixture was then observed in several occasions and was shown that the dilution always remained stable, clear, with no particles and transparent; therefore it was decided to use that combination in the IV infuser for the treatment of postoperative pain, always under the anaesthesiologist supervisión. A total of 118 patients were studied, 46 women (39% and 72 men studied (61%, ASA ITV, mean age 59.75 +/- 14.25 (18-89; 92 (78% underwent general surgery procedures and 26 (22% urologic ones. The filling of infuser according to ASA, age and type of surgery of the patient, was made with: parecoxib 80 mg + metoclopramide CL H 20 or 30 mg + saline solution for the 118 patients, morphine chloride was added in 65 patients, petidine in 30

P. Acín

2007-04-01

216

Insulin and Insulin Resistance  

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As obesity and diabetes reach epidemic proportions in the developed world, the role of insulin resistance and its consequences are gaining prominence. Understanding the role of insulin in wide-ranging physiological processes and the influences on its synthesis and secretion, alongside its actions from the molecular to the whole body level, has significant implications for much chronic disease seen in Westernised populations today. This review provides an overview of insulin, its history, stru...

Wilcox, Gisela

2005-01-01

217

[Effect of insulin on glucose and and fat metabolism in ewes during various reproductive states in normal and hypocalcemia].  

Science.gov (United States)

Metabolic indicators of glucose and lipid metabolism, i.e. glucose turnover, insulin concentration in plasma, insulin clearance, concentrations of non-esterified fatty acids (NEFA), glycerol and potassium were investigated in nine ewes during three reproductive states in order to examine their importance for development of subclinical ketosis. The increase of insulin in plasma was measured after a continuous 60 min intravenous infusion of glucose (4.9 mmol.min-1). Turnover of glucose and insulin clearance were quantified during a combined euglycemic, hyperinsulinemic clamp. Insulin was consecutively infused in doses of 5 and 10 mU.kg-1.min-1 for about 2 1/2 hours, each. Plasma glucose concentration was adjusted to 5.3 to 5.8 mmol.l-1. The experiments were carried out during non-pregnancy and non-lactation, 4 weeks to 3 days before lambing and 3 to 4 weeks after lambing, each during normo- and hypocalcemia. Hypocalcemia (0.9 to 1.0 mmol Ca2+.l-1) was induced by continuous i.v. infusion of a 5% Na-EDTA solution. Infusion rate was continuously adjusted. The glucose induced increase in plasma insulin concentration was significantly lower during late pregnancy compared to peak lactation and non-pregnancy (46.3, 62.4 and 128 mU.l-1, respectively). The insulin clearance during a hyperinsulinemic clamp with 5 mU.kg-1.min-1 was significantly less during late pregnancy compared to peak lactation and non-pregnancy (3.7, 6.0, 4.8 ml.kg-1.min-1, respectively). The concentrations of NEFA and glycerol in plasma during the infusion of 5 mU insulin.kg-1.min-1 were significantly higher during late pregnancy than during non-pregnancy (NEFA: 0.41, 0.04 mmol.l-1; glycerol: 96, 29 mumol.l-1, respectively). The results showed that insulin responsiveness was significantly reduced in sheep during late pregnancy. The insulin-mediated uptake of glucose by muscle and fat tissues and the insulin-mediated inhibition of lipolysis were significantly reduced during late pregnancy compared to non-pregnancy and lactation. The diminished responsiveness of target tissue towards insulin during late pregnancy predisposed the animals for development of subclinical ketosis. Hypocalcemia exaggerated this situation by its inhibitory effect on hepatic gluconeogenesis and by enhancing insulin resistance of target tissues. The factors which are responsible for the altered responsiveness of target tissues towards insulin during late pregnancy are yet unknown. The potassium concentration in plasma showed a proportional increase with increase of the energy deficit of the target tissues. This effect could have been exerted by a decrease in cellular concentration of ATP and a concomitant reduction of the activity of Na(+)-K(+)-ATPase. The indicators of glucose and lipid metabolism which were examined in this study showed marked individual variation, particularly during late pregnancy. The marked changes of these indicators with reproductive stages as well as their great variation between individual sheep support the assumption that they are of significance for the development of pregnancy toxemia in sheep. PMID:9410723

Schlumbohm, C; Sporleder, H P; Gürtler, H; Harmeyer, J

1997-09-01

218

A comparison of continuous infusion of vecuronium and atracurium in midline and paramedian laparotomies.  

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This was a study to compare continuous intravenous infusion of atracurium with continuous intravenous infusion of vecuronium for intraoperative muscle relaxation in 62 ASA I / II patients. Scheduled for laparotomies and pelvic surgeries under general anaesthesia. They were randomly allocated in two groups to receive either vecuronium infusion of 50 microg/kg/hour following a bolus dose of 0.1 microg/kg, or atracurium infusion of 400 microg/kg/hour following a bolus dose of 0.5 microg/kg. The ...

Chaudhari L; Shetty A; Buddhi M; Krishnan G

1999-01-01

219

Stable insulin preparation for implanted insulin pumps. Laboratory and animal trials.  

Science.gov (United States)

The stability and longevity of the polyethylene-polypropylene glycol-stabilized insulin have been tested in vitro and in vivo in an implanted insulin-infusion device, the programmable implantable medication system (PIMS). In vitro tests demonstrated long-term compatibility with refill cycles of up to 3 mo, with a preparation of 400 U/ml. Total test period in vitro was 3.2 device-yr (combined time of device use). Insulin retained 88-93% native structure. A major modification, which was biologically active and nonimmunogenic, was identified and partially characterized. Examination of one device by scanning electron microscopy and X-ray microanalysis after 1 yr of insulin infusion revealed surfaces clean of insulin precipitate or other material along the entire insulin-delivery pathway. Surface analysis of the silicone-lined polyethylene catheters after 6 mo of infusion also showed no evidence of major insulin precipitate. In vivo stability trials were accomplished with PIMS implanted in diabetic dogs with an intraperitoneal delivery site. There has been no insulin blockage of the catheter of active pumps after 5.1 dog-yr (combined time of trials) of trials (up to 5 mo between refills in a single dog). Structural stability of insulin was analyzed by high-performance liquid chromatography. On average, 90.8% of the insulin sampled from the reservoir in vivo was native insulin, with an average of 96.2% retention of active forms. PMID:3315791

Grau, U; Saudek, C D

1987-12-01

220

Intravenous labetalol in the treatment of severe hypertension  

Science.gov (United States)

1 We have compared, in patients with severe hypertension, the administration of intravenous labetalol by single rapid injection, by repeated bolus injections, and by incremental infusion. 2 Incremental infusion was the most consistently (albeit not invariably) effective method, and that least prone to cause side-effects. 3 An occasional very marked decrease in blood pressure was seen with all these techniques but least often with incremental infusion. Thus close and continuous supervision is mandatory. 4 All three methods produced slight but significant decreases in heart rate, and in plasma angiotensin II and aldosterone. 5 Intravenous labetalol was also effective in controlling hypertensive crises of phaeochromocytoma and those following the withdrawal of clonidine. 6 In a total of 70 severely hypertensive patients given intravenous labetalol, none showed adverse neurological or cardiological sequelae. PMID:7093105

Cumming, A. M. M.; Brown, J. J.; Lever, A. F.; Robertson, J. I. S.

1982-01-01

 
 
 
 
221

Evaluating the safety and efficiency of a CPOE system for continuous medication infusions in a pediatric ICU.  

Science.gov (United States)

Critically ill children often require continuous intravenous infusions of life-supporting medications. The complexity of ordering such infusions makes this an error prone process, and such errors can result in serious adverse events. A CPOE system was developed and evaluated to assess its impact on the safety and efficiency of prescribing continuous medication infusions. PMID:17238747

Vaidya, Vinay; Sowan, Azizeh K; Mills, Mary Etta; Soeken, Karen; Gaffoor, Mohamed; Hilmas, Elora

2006-01-01

222

Cardiovascular toxicity of cryopreserved cord blood cell infusion.  

Science.gov (United States)

Although infusion of cryopreserved bone marrow or peripheral blood stem cell is associated with a variety of symptoms, there have been no reports detailing the data of infusion-related toxicities of cryopreserved cord blood (CB) units. We prospectively evaluated the incidence and significance of infusion-related toxicities in 34 adult patients undergoing unrelated CB transplantation. Cryopreserved CB units were thawed and immediately infused, unfiltered, through a central intravenous catheter without further manipulation. Heart rate, blood pressure, oxygen saturation and clinical symptoms were recorded during and after infusion. Twenty-four percent of patients experienced non-cardiovascular toxicities related to infusion. The incidence of systolic and diastolic hypertension and bradycardia was 58, 64 and 32%, respectively. Although three patients (9%) with severe systolic hypertension after the infusion required treatment with antihypertensive agents, no patients experienced life-threatening side effects or needed discontinuation of CB unit infusion. Patient or transplant characteristics had no effect on the hypertension and bradycardia related to the infusion of CB. These data suggest that infusion of cryopreserved CB without further manipulation after thawing is safe and well tolerated. However, cardiovascular toxicities including hypertension and bradycardia were frequently observed. PMID:18209718

Konuma, T; Ooi, J; Takahashi, S; Tomonari, A; Tsukada, N; Kobayashi, T; Sato, A; Kato, S; Kasahara, S; Ebihara, Y; Nagamura-Inoue, T; Tsuji, K; Tojo, A; Asano, S

2008-05-01

223

Insulin resistance and thyroid disorders.  

Science.gov (United States)

Insulin resistance is defined as a glucose homeostasis disorder involving a decreased sensitivity of muscles, adipose tissue, liver and other body tissues to insulin, despite its normal or increased concentration in blood. Insulin resistance may be asymptomatic or occur presenting a variety of disorders, such as: glucose tolerance impairment, type 2 diabetes, as well as hypercholesterolaemia, hypertriglyceridaemia, obesity, and arterial hypertension. Insulin acts via specific receptors present on the surface of most cells of the body. The greatest number of these receptors is found on adipocytes, hepatocytes and striated muscle cells. There are three mechanisms of insulin resistance: pre-receptor, receptor and post-receptor. Multiple methods of assessing insulin resistance are based on the concurrent measurements of glucose and insulin levels in blood serum. The glucose and insulin measurements are conducted in baseline conditions or after intravenous administration of a specific quantity of glucose or insulin. The methods of assessing insulin resistance are divided into direct and indirect. The current 'gold standard' in the assessment of insulin sensitivity is the determination of tissue glucose utilisation using the metabolic clamp technique. The presence of disorders of carbohydrate metabolism has been demonstrated in thyroid disease involving either overt hyperthyroidism or overt hypothyroidism. The severity of the disease is proportional to the severity of these disorders. The possible influence of subclinical forms of both hyperthyroidism and hypothyroidism on carbohydrate disorders is still under discussion. Thyroid hormones have a significant effect on glucose metabolism and the development of insulin resistance. In hyperthyroidism, impaired glucose tolerance may be the result of mainly hepatic insulin resistance, whereas in hypothyroidism the available data suggests that the insulin resistance of peripheral tissues prevails. PMID:24549605

Gierach, Marcin; Gierach, Joanna; Junik, Roman

2014-01-01

224

Current use of intraosseous infusion in Danish emergency departments: a cross-sectional study  

DEFF Research Database (Denmark)

Intraosseous infusion (IOI) is recommended when intravenous access cannot be readily established in both pediatric and adult resuscitation. We evaluated the current use of IOI in Danish emergency departments (EDs).

Molin, Rune; Hallas, Peter

2010-01-01

225

[Antenatal ethanol-fructose infusion for prophylaxis of dyspnoea (author's transl)].  

Science.gov (United States)

The incidence of dyspnoea among immature newborns, delivered after pregancy periods between 28 and 32 weeks, was reduced with statistically secured significance by antepartal intravenous administration of fructose-ethanol infusions to the mother. PMID:547611

Lauckner, W; Retzke, U

1979-01-01

226

Heparina e insulina en el tratamiento de la pancreatitis aguda por hipertrigliceridemia: Experiencia en 5 casos Heparin and/or insulin treatment of acute pancreatitis caused by hypertriglyceridemia  

Directory of Open Access Journals (Sweden)

Full Text Available Background: Hypertriglyceridemia over 1,000 mg/dl can provoke acute pancreatitis and its persistence can worsen the clinical outcome. On the contrary, a rapid decrease in triglyceride level is beneficial. Plasmapheresis has been performed in some patients to remove chylomicrons from the circulation, while heparin and/or insulin have been administered in some other cases to rapidly reduce blood triglycerides. Heparin and insulin stimulate lipoprotein-lipase activity and accelerate chylomicron degradation. Aim: To report five patients with acute pancreatitis treated with heparin and insulin. Patients and methods: Five patients (4 females and 1 male seen in the last two years, who suffered acute pancreatitis induced by hypertriglyceridemia are reported. Initial blood triglyceride levels were above 1,000 mg/dl (range 1,590-8,690 mg/dl. Besides the usual treatment of acute pancreatitis, heparin and/or insulin were administered intravenously in continuous infusion. Heparin dose was guided by usual parameters of blood coagulation, and insulin dose, by serial determinations of blood glucose. Pancreatic necrosis was demonstrated in 4 patients. Results: Serum triglyceride levels decreased to <500 mg/dl within 3 days in all cases. No complication of treatment was observed and all patients survived. Early and late complications of pancreatitis occurred in one patient. Conclusion: Administration of heparin and/or insulin is an efficient alternative to reduce triglyceride levels in patients with acute pancreatitis and hypertriglyceridemia (Rev Méd Chile 2001; 129: 1373-8

Zoltán Berger F

2001-12-01

227

Intravenous Lidocaine for Refractory Chronic Orofacial Pain: Two case reports and a literature review  

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This report presents the results of treatment of two adults, at the Pain Center of Montreal General Hospital, Canada, with intravenous lidocaine for intractable orofacial pain. Repeated lidocaine infusions (1mg/kg in a bolus, followed by 4mg/kg infused over 1 hour) resulted in satisfactory pain relief in both patients, and the drug was well tolerated. Intravenous lidocaine therapy may be considered for intractable orofacial pain; further research is warranted.

Almahrezi, Abdulaziz; Lamb, Louise; Ware, Mark A.; Shir, Yoram; Al-zakwani, Ibrahim

2008-01-01

228

Monosodium glutamate (MSG-obese rats develop glucose intolerance and insulin resistance to peripheral glucose uptake  

Directory of Open Access Journals (Sweden)

Full Text Available Different levels of insulin sensitivity have been described in several animal models of obesity as well as in humans. Monosodium glutamate (MSG-obese mice were considered not to be insulin resistant from data obtained in oral glucose tolerance tests. To reevaluate insulin resistance by the intravenous glucose tolerance test (IVGTT and by the clamp technique, newborn male Wistar rats (N = 20 were injected 5 times, every other day, with 4 g/kg MSG (N = 10 or saline (control; N = 10 during the first 10 days of age. At 3 months, the IVGTT was performed by injecting glucose (0.75 g/kg through the jugular vein into freely moving rats. During euglycemic clamping plasma insulin levels were increased by infusing 3 mU . kg-1 . min-1 of regular insulin until a steady-state plateau was achieved. The basal blood glucose concentration did not differ between the two experimental groups. After the glucose load, increased values of glycemia (P<0.001 in MSG-obese rats occurred at minute 4 and from minute 16 to minute 32. These results indicate impaired glucose tolerance. Basal plasma insulin levels were 39.9 ± 4 µU/ml in control and 66.4 ± 5.3 µU/ml in MSG-obese rats. The mean post-glucose area increase of insulin was 111% higher in MSG-obese than in control rats. When insulinemia was clamped at 102 or 133 µU/ml in control and MSG rats, respectively, the corresponding glucose infusion rate necessary to maintain euglycemia was 17.3 ± 0.8 mg . kg-1 . min-1 for control rats while 2.1 ± 0.3 mg . kg-1 . min-1 was sufficient for MSG-obese rats. The 2-h integrated area for total glucose metabolized, in mg . min . dl-1, was 13.7 ± 2.3 vs 3.3 ± 0.5 for control and MSG rats, respectively. These data demonstrate that MSG-obese rats develop insulin resistance to peripheral glucose uptake

A.E. Hirata

1997-05-01

229

Superselective intraarterial infusion therapy for head and neck carcinomas  

International Nuclear Information System (INIS)

We report the results of superselective intraarterial cisplatin (CDDP) infusion therapy combined with irradiation for 23 patients, mainly advanced head and neck carcinoma. All patients received intraarterial CDDP infusions with intravenous sodium thiosulfate (STS) neutralization. CDDP infusion was performed by the Seldinger's technique in 16 patients and by the implanted intraarterial reservoir system in 7 patients. STS was also infused by the reservoir system implanted at the forearm in most patients. An overall response was observed in 21 of the 23 (91.3%) patients. Complete and partial responses were achieved in 16 (69.6%) and 5 (21.7%) patients, respectively. There were no patients with worse than grade III complications. We concluded that superselective intraarterial infusion therapy with a high dose of CDDP and STS was very effective for the management of advanced head and neck carcinomas and we recommend the implantable reservoir system for both CDDP and STS administration as an easy and low-invasive method. (author)

230

Precision flow-controlled rubidium-82 generator for bolus and constant infusion studies  

International Nuclear Information System (INIS)

A unique flow rate controller and large reservoir pumping system have been developed for infusing rubidium-82 intravenously at bolus, constant, or variable infusion rates. Using rubidium-82 and the positron ring detector tomograph, extraction or flow information can be obtained in studies of the heart, head, or kidneys

231

Motor Stepper Berbasis Mikrokontroller ATMega 8535 Pada Perancangan Sistem Kendali Otomatis Tetesan Cairan Infus Pada Pasien.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The function infuse which is to give intravenous fluids to patients on a regular basis Mistakes in giving intra venous fluids may be detrimental to the patient, also if there are problems with blockage or running out of liquids if not immediately addressed would be dangerous for patients. Infuse the current user is still manually where mistakes – mistakes such as these are still common, there fore we make an infusion control device design that can work automatically and digit...

Nugraha, Arie Yudha

2011-01-01

232

Intravenous iron therapy: how far have we come?  

Directory of Open Access Journals (Sweden)

Full Text Available 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.

Rodolfo Delfini Cançado

2011-12-01

233

Intravenous iron therapy: how far have we come?  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english 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 gastroi [...] ntestinal 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.

Rodolfo Delfini, Cançado; Manuel, Muñoz.

234

Assessment of single-dose benzodiazepines on insulin secretion, insulin sensitivity and glucose effectiveness in healthy volunteers: a double-blind, placebo-controlled, randomized cross-over trial [ISRCTN08745124  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background The present study aimed at investigating in healthy volunteers the effects of diazepam and clonazepam on beta-cell function, insulin sensitivity and glucose effectiveness based on the frequently sampled intravenous (0.5 gkg-1 glucose tolerance test with minimal-model analysis. Methods The study was designed as a double-blind, placebo-controlled, cross-over clinical trial. Diazepam (10 mg and clonazepam (1 mg were infused during 30 min to 15 male subjects with a mean age of 22 years (range: 20–29, after informed consent was given. Benzodiazepines were assayed by capillary gas chromatography with electron capture, insulin by radioimmunoassay and glucose by the enzymatic glucose oxidase method. Results Both benzodiazepines induced significant psychotropic effects. The acute insulin responses (AIR were significantly and negatively correlated with the clonazepam plasma concentrations (r = -0.609, P -1 (median and lower limit of effective therapeutic concentrations: 1.37 ± 0.3 versus 2.84 ± 0.60 × 10-2min-1 (P = 0.028 for the coefficient of glucose tolerance (Kg, 2.18 ± 0.29 versus 3.71 ± 0.89 × 10-4?Uml-1min-1 (P = 0.018 for insulin sensitivity (Si and 1.80 ± 0.39 versus 3.59 ± 0.71 × 10-2min-1 (P = 0.028 for glucose effectiveness at basal insulin (Sg. These parameters were not significantly modified when diazepam was administered; plasma levels of this drug however, were below the effective therapeutic concentrations (300 ng ml-1 from min 15 after the end of the perfusion. Conclusion The present results suggest that a benzodiazepine, in particular clonazepam, may alter insulin secretion and insulin sensitivity after a single administration in healthy volunteers.

Lacarelle Bruno

2004-03-01

235

Insulin pharmacokinetics  

DEFF Research Database (Denmark)

Where adjustments of diet, physical activity, and dosage of insulin are well known to diabetologists and diabetic patients, present-day knowledge of factors of importance to the pharmacokinetics of insulin is frequently ignored. The pharmacokinetics of insulin comprise the absorption process, the distribution including binding to circulating insulin antibodies, if present, and to insulin receptors, and its ultimate degradation and excretion. The distribution and metabolism of absorbed insulin follow that of endogenous insulin. The distribution and metabolism cannot be actively changed, except in the case of circulating insulin antibodies, which in rare cases also may cause insulin resistance. The use of insulin preparation of low immunogeneity will avoid or reduce this course of variation in action. The absorption process, the detailed mechanisms of which are still unknown, is influenced by many variables where some can be controlled, thereby reducing the intrapatient variability in insulin absorption, which may reach 35%, causing a corresponding metabolic lability. Besides the known differences in timing among different preparations, the size of dose, the injected volume, and the insulin concentration are determinants of absorption role. Fortuitous injection technique contributes to variance, as do changes in blood flow of the injected tissue. This may be induced by changes in ambient temperature, exercise of injected limb, or local massage. Regional differences are also due to differences in blood flow. Serum insulin peaks may peak up to 1 h after injection of soluble insulin into the thigh versus into the abdominal wall. Local degradation of insulin seems of less importance but may, in rare cases, be the cause of high insulin "requirements." Available evidence is reviewed and the importance of implementing the consequences in the daily care of the insulin-treated patient is emphasized.

Binder, C; Lauritzen, Torsten

1984-01-01

236

Insulin Test  

Science.gov (United States)

... a Glance Why Get Tested? To help evaluate insulin production by the beta cells in the pancreas; to ... and your health practitioner wants to monitor your insulin production; sometimes when it is suspected that you have ...

237

A model of GLP-1 action on insulin secretion in nondiabetic subjects.  

Science.gov (United States)

Glucagon-like peptide-1 (GLP-1)-based therapies for diabetes have aroused interest because of their effects on insulin secretion and glycemic control. However, a mechanistic model enabling quantitation of pancreatic response to GLP-1 has never been developed. To develop such a model we studied 88 healthy individuals (age 26.3 +/- 0.6 yr, BMI 24.9 +/- 0.4 kg/m(2)) by use of a hyperglycemic clamp. A variable infusion maintained glucose concentrations at 150 mg/dl for 240 min. At 120 min, an intravenous infusion of GLP-1 was started (0.75 pmol kg(-1) min(-1) from 120-180 min, 1.5 pmol kg(-1) min(-1) from 181-240 min). Consequently, plasma C-peptide concentration rose from 1,852.0 +/- 62.8 pmol/l at 120 min to 4,272.2 +/- 176.4 pmol/l at 180 min and to 6,995.8 +/- 323.5 pmol/l at 240 min. Four models of GLP-1 action on insulin secretion were considered. All models share the common assumption that insulin secretion is made up of two components, one proportional to glucose rate of change through dynamic responsivity, Phi(d), and one proportional to glucose through static responsivity, Phi(s), but differing by modality of GLP-1 control. The model that best fit C-peptide data assumes that above-basal insulin secretion depends linearly on GLP-1 concentration and its rate of change. An index (Pi) measuring the percentage increase of secretion due to GLP-1 is derived. Before GLP-1 infusion, Phi(d) = 245.7 +/- 15.6 10(-9) and Phi(s) = 25.2 +/- 1.4 10(-9) min(-1). Under GLP-1 stimulus, Pi = 12.6 +/- 0.71% per pmol/l, meaning that an increase of 5 pmol/l in peripheral GLP-1 concentrations induces an approximately 60% increase in over-basal insulin secretion. PMID:20179243

Dalla Man, Chiara; Micheletto, Francesco; Sathananthan, Airani; Rizza, Robert A; Vella, Adrian; Cobelli, Claudio

2010-06-01

238

Lipid induced insulin resistance affects women less than men and is not accompanied by inflammation or impaired proximal insulin signaling  

DEFF Research Database (Denmark)

AbstractObjective: We have previously shown that overnight fasted women have higher insulin stimulated whole body and leg glucose uptake despite a higher intramyocellular triacylglycerol concentration than men. Women also express higher muscle mRNA levels of proteins related to lipid metabolism than men. We therefore hypothesized that women would be less prone to lipid induced insulin resistance. Research and design methods: Insulin sensitivity of whole body and leg glucose disposal was studied in 16 young well matched healthy men and women infused with intralipid or saline for 7h. Muscle biopsies were obtained before and during a euglycemic hyperinsulinemic (1.42 mU·kg(-1)·min(-1)) clamp. Results: Intralipid infusion reduced whole body glucose infusion rate 26% in women and 38% in men (p<0.05) and insulin stimulated leg glucose uptake was reduced significantly less in women (45%) than men (60%) after intralipid infusion. Hepatic glucose production was decreased during the clamp similarly in women and men irrespective of intralipid infusion. Intralipid did not impair insulin or AMPK signaling in muscle and subcutaneous fat, did not cause accumulation of muscle lipid intermediates, and did not impair insulin stimulated glycogen synthase activity in muscle or increase plasma concentrations of inflammatory cytokines. In vitro glucose transport in giant sarcolemmal vesicles was not decreased by acute exposure to fatty acids. Leg lactate release was increased and respiratory exchange ratio was decreased by intralipid. Conclusion: Intralipid infusion causes less insulin resistance of muscle glucose uptake in women than in men. This insulin resistance is not due to decreased canonical insulin signaling, accumulation of lipid intermediates, inflammation or direct inhibition of glucose transporter activity. A higher leg lactate release and lower glucose oxidation with intralipid infusion may rather suggest a metabolic feed back regulation of glucose metabolism.

HØeg, Louise D; SjØberg, Kim Anker

2011-01-01

239

Insulin secretion, insulin sensitivity, and hepatic insulin extraction in first-degree relatives of type 2 diabetic patients  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english To identify early metabolic abnormalities in type 2 diabetes mellitus, we measured insulin secretion, sensitivity to insulin, and hepatic insulin extraction in 48 healthy normal glucose-tolerant Brazilians, first-degree relatives of type 2 diabetic patients (FH+). Each individual was matched for sex [...] , age, weight, and body fat distribution with a person without history of type 2 diabetes (FH-). Both groups were submitted to a hyperglycemic clamp procedure (180 mg/dl). Insulin release was evaluated in its two phases. The first was calculated as the sum of plasma insulin at 2.5, 5.0, 7.5, and 10.0 min after the beginning of glucose infusion, and the second as the mean plasma insulin level in the third hour of the clamp procedure. Insulin sensitivity index (ISI) was the mean glucose infusion rate in the third hour of the clamp experiment divided by the mean plasma insulin concentration during the same period of time. Hepatic insulin extraction was determined under fasting conditions and in the third hour of the clamp procedure as the ratio between C-peptide and plasma insulin levels. FH+ individuals did not differ from FH- individuals in terms of the following parameters [median (range)]: a) first-phase insulin secretion, 174 (116-221) vs 207 (108-277) µU/ml, b) second-phase insulin secretion, 64 (41-86) vs 53 (37-83) µU/ml, and c) ISI, 14.8 (9.0-20.8) vs 16.8 (9.0-27.0) mg kg-1 min-1/µU ml-1. Hepatic insulin extraction in FH+ subjects was similar to that of FH- ones at basal conditions (median, 0.27 vs 0.27 ng/µU) and during glucose infusion (0.15 vs 0.15 ng/µU). Normal glucose-tolerant Brazilian FH+ individuals well-matched with FH- ones did not show defects of insulin secretion, insulin sensitivity, or hepatic insulin extraction as tested by hyperglycemic clamp procedures.

W.P., Pimenta; M.L., Santos; N.S., Cruz; F.F., Aragon; C.R., Padovani; J.E., Gerich.

240

A Micro-PIV Study of the Pulsed Micro-Flows Driven by an Insulin Pump  

Science.gov (United States)

In recent years, there is a surge in the popularity of using insulin pump or continuous subcutaneous insulin infusion therapy, as opposed to multiple daily injections by insulin syringe or an insulin pen. Some case studies have suggested that insulin delivery failure may be caused by precipitation of insulin within the infusion set. Speculation also exists that the flow of insulin through an insulin infusion set may be reduced or inhibited by air bubbles entrained into the micro-sized tubing system since there are chances that air be introduced into the insulin reservoir during the filling process. In the present study, a microscopic Particle Image Velocimtry (micro-PIV) system was used to characterize the transient behavior of the pulsed micro-flows inside the micro-sized tubing system of an insulin infusion set with insulin pump operating in basal mode (i.e., pulsed insulin pumping). The effects of the air bubbles entrained into the micro-sized tubing system on the insulin delivery process were assessed based on the micro-PIV measurements.

Wang, Bing; Demuren, Ayodeji; Gyuricsko, Eric; Hu, Hui

2009-11-01

 
 
 
 
241

Continuous ampicillin infusion as an alternative to intermittent infusion for adult inpatients: A case series.  

Science.gov (United States)

Intravenous ampicillin has been extensively used for various kinds of infections for more than fifty years. This drug is administered intermittently, which can result in missed or delayed drug administration and sleep interruption that can have a negative impact on the quality of life during hospitalization. Continuous infusion may solve these concerns. We reviewed the cases of five patients who were treated with continuous ampicillin infusions in our hospital. The ampicillin serum concentrations were from 11.3 to 32.8 ?g/mL, which was above the ampicillin MICs of the causative organisms, ?0.06 to 4 ?g/mL. Although the dosages given of ampicillin varied in each case, the serum concentrations showed a strong correlation with creatinine clearance (r(2) = 0.91). All the patients improved at the time of discharge, or transfer to another hospital, with no significant complications during the continuous infusion. Continuous ampicillin infusion could be a better alternative for frequent intermittent infusion for adult inpatients with infections due to ampicillin-susceptible organisms. PMID:24972584

Ogawa, Taku; Kasahara, Kei; Ikawa, Kazuro; Shigeta, Junichi; Komatsu, Yuko; Kuruno, Noriko; Uno, Kenji; Maeda, Koichi; Mikasa, Keiichi

2014-10-01

242

Continuous-infusion adriamycin  

International Nuclear Information System (INIS)

This chapter discusses the diminished cardiotoxicity as well as diminished nausea and vomiting with continuous infusions of adriamycin to patients undergoing radiation therapy, particularly with infusions of 48 hours or longer, and best with 96-hour infusions, the longest duration that has been studied systematically. In breast cancer, data show that more adriamycin is better, but only for a selected subgroup of patients: those with complete remission. The diminished cardiotoxicity makes the use of adriamycin more attractive in the adjuvant situation, where increased safety will decrease the chances of long-term complications and make retreatment easy for cured patients who develop second malignancies

243

Clinical and economic evidence for intravenous acetaminophen.  

Science.gov (United States)

Intravenous acetaminophen received United States Food and Drug Administration approval in November 2010 for the management of mild-to-moderate pain, management of moderate-to-severe pain with adjunctive opioid analgesics, and reduction of fever. Although intravenous acetaminophen generally improved pain relief and demonstrated opioid-sparing effects compared with placebo, it did not consistently reduce the frequency of opioid-related adverse events (e.g., postoperative nausea and vomiting). The safety and efficacy of intravenous acetaminophen as an antipyretic agent have been documented in adults and children; however, its cost is several-fold higher than that of the oral and rectal formulations. Although use of intravenous acetaminophen has reduced other postoperative resource utilization (e.g., hospital length of stay) in some studies outside the United States in patients undergoing abdominal surgery, a full economic evaluation in the United States has yet to be undertaken. In addition, its administration time (15-min infusion) and packaging (glass, single-use vial) have the potential to adversely affect patient flow in the postanesthesia care unit, create burden on patient care units, and lead to drug waste. Furthermore, 1 g of intravenous acetaminophen is formulated in 100 ml of solution, which may be an issue for patients with fluid restrictions. Given the clinical and economic evidence currently available, intravenous acetaminophen should not replace oral or rectal acetaminophen, but its use may be considered in a limited number of patients who cannot receive drugs orally and rectally and who cannot tolerate other parenteral nonopioid analgesic or antipyretic agents. PMID:22570116

Yeh, Yu-Chen; Reddy, Prabashni

2012-06-01

244

Advancing medication infusion safety through the clinical integration of technology.  

Science.gov (United States)

Adverse drug events resulting from errors in prescribing or administering medications are preventable. Within a hospital system, numerous technologies are employed to address the common sources of medication error, including the use of electronic medical records, physician order entry, smart infusion pumps, and barcode medication administration systems. Infusion safety is inherently risky because of the high-risk medications administered and the lack of integration among the stand-alone systems in most institutions. Intravenous clinical integration (IVCI) is a technology that connects electronic medical records, physician order entry, smart infusion pumps, and barcode medication administration systems. It combines the safety features of an automatically programmed infusion pump (drug, concentration, infusion rate, and patient weight, all auto-programmed into the device) with software that provides visibility to real-time clinical infusion data. Our article describes the characteristics of IVCI at WellSpan Health and its impact on patient safety. The integrated infusion system has the capability of reducing medication errors, improving patient care, reducing in-facility costs, and supporting asset management. It can enhance continuous quality improvement efforts and efficiency of clinical work flow. After implementing IVCI, the institution realized a safer patient environment and a more streamlined work flow for pharmacy and nursing. PMID:24145584

Gerhart, Donald; O'Shea, Kristen; Muller, Sharon

2013-01-01

245

Dissociation between fat-induced in vivo insulin resistance and proximal insulin signaling in skeletal muscle in men at risk for type 2 diabetes.  

DEFF Research Database (Denmark)

The effect of short- (2 h) and long-term (24 h) low-grade Intralipid infusion on whole-body insulin action, cellular glucose metabolism, and proximal components of the insulin signal transduction cascade was studied in seven obese male glucose intolerant first degree relatives of type 2 diabetic patients [impaired glucose tolerance (IGT) relatives] and eight matched control subjects. Indirect calorimetry and excision of vastus lateralis skeletal muscle biopsies were performed before and during hyperinsulinemic euglycemic clamps combined with 3[(3)H]glucose. Clamps were performed after 0, 2, or 24 h Intralipid infusion (0.4 ml.kg(-1).min(-1)). Insulin-stimulated glucose disposal decreased approximately 25% after short- and long-term fat infusion in both IGT relatives and controls. Glucose oxidation decreased and lipid oxidation increased after both short- and long-term fat infusion in both groups. Insulin-stimulated glucose oxidation was higher after long-term as compared with short-term fat infusion in control subjects. Short- or long-term infusion did not affect the absolute values of basal or insulin-stimulated insulin receptor substrate-1 tyrosine phosphorylation, tyrosine-associated phosphoinositide 3-kinase (PI 3-kinase) activity, insulin receptor substrate-1-associated PI 3-kinase activity, or Akt serine phosphorylation in IGT relatives or matched controls. In fact, a paradoxical increase in both basal and insulin-stimulated PI 3-kinase activity was noted in the total study population after both short- and long-term fat infusion. Short- and long-term low-grade Intralipid infusion-induced (or enhanced) whole-body insulin resistance and impaired glucose metabolism in IGT relatives and matched control subjects. The fat-induced metabolic changes were not explained by impairment of the proximal insulin signaling transduction in skeletal muscle.

Storgaard, Heidi; Jensen, Christine B

2004-01-01

246

Intrahippocampal Insulin Improves Memory in a Passive-Avoidance Task in Male Wistar Rats  

Science.gov (United States)

The main impacts of insulin favor the peripheral organs. Although it functions as a neuropeptide, insulin possesses also some central effects. The aim of this study was to determine the effect of intrahippocampal infusion of insulin on passive avoidance learning in healthy male rats. Thirty male wistar rats were divided into three groups (n = 10…

Babri, Shirin; Badie, Hamid Gholamipour; Khamenei, Saeed; Seyedlar, Mehdi Ordikhani

2007-01-01

247

Pressão arterial, respostas metabólicas e autonômicas à insulina e infusão de intralipid® em pacientes chagásicos / Blood pressure, metabolic and autonomic responses to insulin and intralipid® infusion in chagasic patients / Presión arterial, respuestas metabólicas y autonómicas a la insulina e infusión de intralipid® en pacientes chagásicos  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese FUNDAMENTO: Infusão de intralipid e heparina resulta em aumento da pressão arterial e também em anormalidades autonômicas em indivíduos normais e hipertensos. OBJETIVO: Avaliar a sensibilidade a insulina e o impacto da infusão de intralipid e de heparina (ILH) sobre a resposta hemodinâmica, metabóli [...] ca e autonômica em pacientes com a forma indeterminada da doença de Chagas. MÉTODOS: Doze pacientes com a forma indeterminada da doença de Chagas e 12 voluntários saudáveis foram avaliados. RESULTADOS: A pressão arterial basal e a frequência cardíaca foram semelhantes nos dois grupos. Os níveis plasmáticos de noradrenalina encontravam-se ligeiramente aumentados no grupo de pacientes chagásicos. Após o Teste de Tolerância a Insulina (TTI), houve um declínio significativo na glicose dos dois grupos. A Infusão de ILH resultou em aumento da pressão arterial em ambos os grupos, mas não houve nenhuma mudança significativa na noradrenalina plasmática. O componente de Baixa Frequência (BF) mostrou-se semelhante e aumentou de forma semelhante em ambos os grupos. O componente de Alta Frequência (AF) apresentou-se menor no grupo chagásico. CONCLUSÃO: Pacientes com forma indeterminada da doença de Chagas apresentaram aumento da atividade simpática no momento basal e uma resposta inadequada à insulina. Eles também tiveram um menor componente de alta frequência e sensibilidade barorreflexa prejudicada no momento basal e durante a infusão de intralipid e heparina. Abstract in spanish FUNDAMENTO: La Infusión de intralipid® y de heparina trae como resultado un aumento de la presión arterial y también de las anormalidades autonómicas en los individuos normales e hipertensos. OBJETIVO: Evaluar la sensibilidad a la insulina y el impacto de la infusión de intralipid® y de heparina (IL [...] H) sobre la respuesta hemodinámica, metabólica y autonómica en pacientes con la forma indefinida de la Enfermedad de Chagas. MÉTODOS: Fueron evaluados doce pacientes con la forma indefinida de la Enfermedad de Chagas y 12 voluntarios sanos. RESULTADOS: La presión arterial basal y la frecuencia cardíaca fueron similares en los dos grupos. Los niveles plasmáticos de noradrenalina estaban ligeramente más elevados en el grupo de pacientes chagásicos. Después del Test de Tolerancia a la Insulina (TTI), se produjo una ostensible disminución en la glucosa de los dos grupos. La Infusión de ILH trajo como consecuencia el aumento de la presión arterial en ambos grupos, pero no hubo ningún cambio significativo en la noradrenalina plasmática. El componente de Baja Frecuencia (BF), fue similar y aumentó de forma parecida en ambos grupos. El componente de Alta Frecuencia (AF) se presentó con un menor nivel en el grupo chagásico. CONCLUSIONES: Los pacientes con una forma indeterminada de la Enfermedad de Chagas, presentaron un aumento en la actividad simpática al momento basal y una respuesta inadecuada a la insulina. También tuvieron un menor componente de alta frecuencia y de sensibilidad barorrefleja, que fue perjudicado en el momento basal y durante la infusión de intralipid® y heparina. Abstract in english BACKGROUND: Intralipid and heparin infusion results in increased blood pressure and autonomic abnormalities in normal and hypertensive individuals. OBJECTIVE: To evaluate insulin sensitivity and the impact of Intralipid and heparin (ILH) infusion on hemodynamic, metabolic, and autonomic response in [...] patients with the indeterminate form of Chagas' disease. METHODS: Twelve patients with the indeterminate form of Chagas' disease and 12 healthy volunteers were evaluated. RESULTS: Baseline blood pressure and heart rate were similar in both groups. Plasma noradrenaline levels were slightly increased in the Chagas' group. After insulin tolerance testing (ITT), a significant decline was noted in glucose in both groups. ILH infusion resulted in increased blood pressure in both groups, but there was no significant change i

Claudia Cristina Soares, Silva; Carlos Alberto Martins, Santos; Cristiano, Mostarda; Eduardo Moacyr, Krieger; Heno Ferreira, Lopes.

248

Glucose tolerance, insulin release, and insulin binding to monocytes in kidney transplant recipients  

International Nuclear Information System (INIS)

In order to evaluate glucose tolerance following renal transplantation, intravenous glucose tolerance tests (IVGTT), with evaluation of hormonal responses to the intravenous glucose load and percent specific 125I-insulin binding to peripheral blood monocytes, were studied in eight clinically stable kidney transplant recipients. For comparison purposes, identical studies were done in eight control subjects and seven clinically stable hemodialysis patients. One transplant recipient was glucose intolerant, with fasting hyperglycemia, elevated HbA1C, and abnormal glucose decay constant. Impaired pancreatic insulin release appeared to be the major factor accounting for his glucose intolerance. The seven glucose-tolerant transplant recipients had significantly increased insulin release during IVGTT compared to control subjects, and significant correlations were found among insulin release, glucose decay constant, and fasting blood sugar in those patients. Insulin binding to monocytes was significantly greater in transplant recipients than control subjects due to an increase in insulin binding capacity per cell. A significant correlation was found between percent specific 125I-insulin binding and steroid dose, expressed as mg/kg body weight/day, in those patients. Thus, chronic steroid administration does not cause glucose intolerance in transplant recipients who manifest steroid-associated increases in pancreatic insulin release and cellular insulin binding capacity

249

Insulin aspart pharmacokinetics : An assessment of its variability and underlying mechanisms  

DEFF Research Database (Denmark)

Background: Insulin aspart (IAsp) is used by many diabetics as a meal-time insulin to control postprandial glucose levels. As is the case with many other insulin types, the pharmacokinetics (PK), and consequently the pharmacodynamics (PD), is associated with clinical variability, both between and within individuals. The present article identifies the main physiological mechanisms that govern the PK of IAsp following subcutaneous administration and quantifies them in terms of their contribution to the overall variability. Material and methods: CT scanning data from Thomsen et al. (2012) are used to investigate and quantify the properties of the subcutaneous depot. Data from Brange et al. (1990) are used to determine the effects of insulin chemistry in subcutis on the absorption rate. Intravenous (i.v.) bolus and infusion PK data for human insulin are used to understand and quantify the systemic distribution and elimination (Porksen et al., 1997; Sjostrand et al., 2002). PK and PD profiles for type 1 diabetics from Chen et al. (2005) are analyzed to demonstrate the effects of IAsp antibodies in terms of bound and unbound insulin. PK profiles from Thorisdottir et al. (2009) and Ma et al. (2012b) are analyzed in the nonlinear mixed effects software Monolix (R) to determine the presence and effects of the mechanisms described in this article. Results: The distribution of IAsp in the subcutaneous depot show an initial dilution of approximately a factor of two in a single experiment. Injected insulin hexamers exist in a chemical equilibrium with monomers and dimers, which depends strongly on the degree of dilution in subcutis, the presence of auxiliary substances, and a variety of other factors. Sensitivity to the initial dilution in subcutis can thus be a cause of some of the variability. Temporal variations in the PK are explained by variations in the subcutaneous blood flow. IAsp antibodies are found to be a large contributor to the variability of total insulin PK in a study by Chen et al. (2005), since only the freefraction is eliminated via the receptors. The contribution of these and other sources of variability to the total variability is quantified via a population PK analysis and two recent clinical studies (Thorisdottir et al., 2009; Ma et al., 2012b), which support the presence and significance of the identified mechanisms. Conclusions: IAsp antibody binding, oligomeric transitions in subcutis, and blood flow dependent variations in absorption rate seem to dominate the PK variability of IAsp. It may be possible via e.g. formulation design to reduce some of these variability factors. (C) 2014 Elsevier B.V. All rights reserved.

Rasmussen, Christian Hove; Roge, Rikke Meldgaard

2014-01-01

250

Effects of a change in the pattern of insulin delivery on carbohydrate tolerance in diabetic and nondiabetic humans in the presence of differing degrees of insulin resistance.  

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While it is well established that people with non-insulin dependent diabetes mellitus have defects in both insulin secretion and action, the relative contribution of each to glucose intolerance is not known. Therefore, nondiabetic (lean and obese) and non-insulin dependent diabetes mellitus subjects were studied on two occasions. On each occasion, insulin secretion was inhibited with somatostatin and glucose was infused in a pattern and amount that mimicked the systemic delivery rate normally...

1996-01-01

251

Pharmacokinetics as applied to total intravenous anaesthesia. Practical implications.  

Science.gov (United States)

In six patients undergoing gynaecological surgery computer assisted total intravenous anaesthesia (CATIA) was performed using etomidate and alfentanil. Constant plasma levels of etomidate (0.3 microgram/ml) from the very beginning onwards were achieved using the so called B.E.T. infusion scheme. Alfentanil plasma concentrations of 0.45 microgram/ml were maintained by the same infusion scheme beginning with skin incision until 20 minutes prior to the end of surgery. The proposed concept of CATIA provided an adequate analgesic and hypnotic effect during anaesthesia for abdominal surgery with a recovery period of short duration. PMID:6135368

Schüttler, J; Schwilden, H; Stoekel, H

1983-07-01

252

Infusion-embolization.  

Science.gov (United States)

Transcatheter intra-arterial therapy for the cancer patient encompasses infusion of chemotherapy and embolization. Intra-arterial infusion of chemotherapeutic agents has been resurrected because of the availability of new drugs, combinations of drugs, and the capability of percutaneous selective catheter placement. Intra-arterial infusion has been effective in patients with carcinomas of the liver, bladder, prostate, uterus, ovary, and lung and in bone and soft tissue sarcomas, melanomas, and tumors of the brain. Embolization of the arterial supply, creating ischemia of the neoplasm, has been employed in the therapeutic management of patients with primary and secondary neoplasms of the liver, kidney, and bone. The median survival of 100 patients with neoplasms of the liver from the time of hepatic artery embolization was 11.5 months. In 100 patients with pulmonary metastases from carcinoma of the kidney, 28 experienced a response to renal artery embolization, a therapeutic delay of 4 to 7 days, nephrectomy, and Depo-Provera (medroxyprogesterone). Seven of 12 patients with giant cell tumor of the pelvis and lumbar spine responded to arterial embolization after all other therapy failed. Chemoembolization, the combination of arterial infusion of chemotherapy and embolization, can be accomplished by the use of microencapsulated agents, liposomes, and particulate emboli with drugs. This approach integrates the advantages of infusion and occlusion, and has considerable potential. Intra-arterial immunotherapy has been initiated with bacillus Calmette-Guerin (BCG) administration into renal neoplasms in patients with metastatic disease. PMID:6093984

Wallace, S; Charnsangavej, C; Carrasco, C H; Bechtel, W

1984-12-01

253

New insulins and insulin therapy.  

Science.gov (United States)

The introduction of the so-called 'designer' insulins, the insulin analogues, has offered new opportunities in the clinical management of diabetes. Two additional new entities are close to reaching clinical practice. Linjeta™ (formally called VIAject) is not an analogue but rather a different formulation of human insulin which may give it a more rapid onset of action, potentially even faster than the currently available rapid-acting insulin analogues. Degludec™, on the other hand, is an insulin analogue molecule with an ultra-long clinical profile derived from the soluble multi-hexamer formation, resulting in a continuous slow and stable release of insulin degludec monomers which may last longer than currently available long-acting analogues. As with any new type of drug, the safety of the 'designer' insulins has to be closely scrutinised. Last year the increased cancer risk in diabetes entered the spotlight and the potential role of insulin analogues led to controversial discussions. In spite of recent new in vitro and observational data no new conclusive evidence became available. The need for multiple well-conducted and appropriately designed prospective observational studies to follow up the effectiveness and safety of the new insulins and the new insulin treatment regimens remains. In this chapter it was our mission to chose articles published about "new insulins" over the last year that have the most important contribution for the on-going development of ultra-fast- and ultra-long-acting insulin analogs and preparations and their potential side-effects, particularly cancer. This has been done by means of PubMed searches as well as a review of abstracts of the recent large international diabetes meetings such as ADA, EASD and ISPAD. PMID:21323810

Danne, T; Bolinder, J

2011-02-01

254

Disposition of intravenous radioactive acyclovir  

International Nuclear Information System (INIS)

The kinetic and metabolic disposition of (8-14C)acyclovir (ACV) was investigated in five subjects with advanced malignancy. The drug was administered by 1-hr intravenous infusion at doses of 0.5 and 2.5 mg/kg. Plasma and blood radioactivity-time, and plasma concentration-time data were defined by a two-compartment open kinetic model. There was nearly equivalent distribution of radioactivity in blood and plasma. The overall mean plasma half-life and total body clearance +/- SD of ACV were 2.1 +/- 0.5 hr and 297 +/- 53 ml/min/1.73 m2. Binding of ACV to plasma proteins was 15.4 +/- 4.4%. Most of the radioactive dose excreted was recovered in the urine (71% to 99%) with less than 2% excretion in the feces and only trace amounts in the expired Co2. Analyses by reverse-phase high-performance liquid chromatography indicated that 9-(carboxymethoxymethyl)guanine was the only significant urinary metabolite of ACV, accounting for 8.5% to 14.1% of the dose. A minor metabolite (less than 0.2% of dose) had the retention time of 8-hydroxy-9-[(2-hydroxyethoxy)methyl]guanine. Unchanged urinary ACV ranged from 62% to 91% of the dose. There was no indication of ACV cleavage to guanine. Renal clearance of ACV was approximately three times the corresponding creatinine clearances

255

Intravenous adenosine SPECT thallium imaging  

International Nuclear Information System (INIS)

This paper determines the safety and efficacy of intravenous (IV) adenosine in females for the evaluation of coronary artery disease, since only limited data are available. Eighty consecutive studies of 78 female subjects (aged 43-83 years) using IV adenosine (0.14 mg/kg per minute) with T1-201 SPECT imaging were reviewed. Fifty-eight (73%) had mild symptoms; mild dyspnea (24%), flushing (23%), chest pain (23%), headache (11%), dizziness (11%), weakness (9%), nausea (8%), abdominal pain (8%), arm pain (6%), chest tightness (4%), neck tightness (4%), dry mouth (4%), and dropped P waves (4%). Four had moderate symptoms: dyspnea requiring Proventil or aminophylline (2%), significant hypotension (1%), and third-degree atrioventicular heart block (1%). Two had severe symptoms (ventricular tachycardia requiring cardioversion (1%) and severe dyspnea requiring epinephrine (1%). Twenty-two (28%) underwent cardiac catheterization that demonstrated coronary artery disease or postangioplasty results. The thallium SPECT images were 94% sensitive and 100% specific in detecting significant disease. The one false-negative result was in a subject who experienced no symptoms for ECG changes during adenosine infusion. Ischemic ECG changes were 35% sensitive and 100% specific. Chest pain was 53% sensitive and 60% specific

256

Dissociation of the effects of epinephrine and insulin on glucose and protein metabolism  

International Nuclear Information System (INIS)

The separate and combined effects of insulin and epinephrine on leucine metabolism were examined in healthy young volunteers. Subjects participated in four experimental protocols: (1) euglycemic insulin clamp (+80 microU/ml), (2) epinephrine infusion (50 ng.kg-1.min-1) plus somatostatin with basal replacement of insulin and glucagon, (3) combined epinephrine (50 ng.kg-1.min-1) plus insulin (+80 microU/ml) infusion, and (4) epinephrine and somatostatin as in study 2 plus basal amino acid replacement. Studies were performed with a prime-continuous infusion of [1-14C]leucine and indirect calorimetry. Our results indicate that (1) hyperinsulinemia causes a generalized decrease in plasma amino acid concentrations, including leucine; (2) the reduction in plasma leucine concentration is primarily due to an inhibition of endogenous leucine flux; nonoxidative leucine disposal decreases after insulin infusion; (3) epinephrine, without change in plasma insulin concentration, reduces plasma amino acid levels; (4) combined epinephrine-insulin infusion causes a greater decrease in plasma amino levels than observed with either hormone alone; this is because of a greater inhibition of endogenous leucine flux; and (5) when basal amino acid concentrations are maintained constant with a balanced amino acid infusion, epinephrine inhibits the endogenous leucine flux. In conclusion, the present results do not provide support for the concept that epinephrine is a catabolic hormone with respect to amino acid-protein metabolism. In contrast, epinephrine markedly inhibits insulin-mediated glucose metabolism

257

Behaviour of homologous 125I fibrinogen after thrombin and ancrod infusion in rabbits  

International Nuclear Information System (INIS)

The behaviour of radioactively labelled fibrinogen after infusion of thrombin or ancrod is investigated. Common factors and differences in the behaviour of fibrinogen after infusion of these two enzymes, which act proteolytically on the fibrinogen, are dealt with. Rabbits received an i.v. injection of homologous 125I-fibrinogen 3 days before ancrod or thrombin infusion. On the day of the experiments, one group of animals received an ancrod infusion (1.5 U/kg body weight for 30 minutes), the other a thrombin infusion (600 U/kg body weight for 60 minutes). Intravenous ancrod and thrombin infusions lowered the fibrinogen level to 30% or 50% of the initial value due to intravascular coagulation. About 50% of the 125I fibrinogen was transformed after ancrod exposure into a non-coagulating fraction of fibrinogen derivatives which produces no fibrinolytic decomposition products. (orig./AJ)

258

Continuous radioisotope infusion  

International Nuclear Information System (INIS)

Continuous infusion of a radioactive marker was used instead of a conventional bolus injection to improve haemodynamic studies. Tc-99m was infused into the blood circulation at a constant rate for 100-300 seconds and the activity in the target structure was measured by a gamma camera with a computer system or by a single detector. The concentration of the marker increased linearly at the same rate throughout the circulating system. Due to variations in transport time from infusion site to different parts of the system the rise of activity occurred at different times. A theory for the calculations was presented and consequently confirmed in a model study. Blood flow patterns in artificial kidneys and alterations in renal blood flow induced by angiotensin were studied. The results are presented as time-function curves or as computer images. This technique can be used to evaluate distributions and alterations of flow in separate parts of a complex circulating system. (author)

259

Chronic exposure to free fatty acid reduces pancreatic beta cell insulin content by increasing basal insulin secretion that is not compensated for by a corresponding increase in proinsulin biosynthesis translation.  

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The pancreatic beta cell normally maintains a stable balance among insulin secretion, insulin production, and insulin degradation to keep optimal intracellular stores of the hormone. Elevated levels of FFA markedly enhance insulin secretion; however, the effects of FFA on insulin production and intracellular stores remain unclear. In this study, twofold elevation in total circulating FFA effected by infusion of lard oil and heparin into rats for 6 h under normoglycemic conditions resulted in ...

Bollheimer, L. C.; Skelly, R. H.; Chester, M. W.; Mcgarry, J. D.; Rhodes, C. J.

1998-01-01

260

Insulin pumps--still a research tool?  

DEFF Research Database (Denmark)

Long-term near-normal blood glucose regulation is possible with portable insulin pumps, and this treatment is acceptable to patients, but is also expensive. The pharmacokinetic difference between continuous subcutaneous insulin infusion and conventional injection therapy is discussed and can explain the difference between the obtained levels of blood glucose control. One-year near-normal blood glucose regulation cannot prevent the development of proliferative retinopathy in patients with established diabetic background retinopathy. Long-term large-scale prospective clinical trials are needed to evaluate whether strict metabolic control can prevent, delay, arrest, or even reverse microvascular complications. Furthermore, the side effects of the pump treatment need to be clarified before routine use of continuous subcutaneous insulin infusion. While awaiting these studies, the only indication for pump therapy in routine clinic is considerable glycaemic instability which is incompatible with leading a normal life.

Lauritzen, Torsten; Pramming, S

1984-01-01

 
 
 
 
261

Effects of intravenous methyl palmoxirate on the turnover and oxidation of fatty acids in conscious dogs  

International Nuclear Information System (INIS)

Methyl palmoxirate (MP) is a member of a class of hypoglycemic agents that inhibit fatty acid oxidation in vitro. The studies presented here were undertaken to determine the effects of intravenous (IV) MP on tracer-determined rates of fatty acid oxidation and systemic adipose tissue lipolysis in dogs. MP (40 mg/kg) was administered IV to five mongrel dogs using a primed continuous infusion of [1-14C]palmitate to determine palmitate kinetics. Palmitate concentration and rate of appearance decreased rapidly (from 155 +/- 25 to 47 +/- 6 mumol/L and 2.9 +/- 0.5 to 0.9 +/- 0.2 mumol.kg-1.min-1, respectively, at 15 minutes, both P less than .05). Palmitate oxidation also decreased, from 1.5 +/- 0.4 to 0.3 +/- 0.1 mumol.kg-1.min-1, P less than .05. Oxidative clearance decreased by approximately 50% 90 minutes after MP administration (P less than .05). Fractional oxidation of palmitate also decreased by approximately 40% (P less than .05). Plasma insulin increased from 45 +/- 6 to 240 +/- 93 pmol/L at 15 minutes (P less than .05). Plasma glucose decreased over the course of study by approximately 20% (P less than .05). In summary, MP has a specific inhibitory effect on plasma free fatty acid (FFA) oxidation in dogs, confirming previous in vitro observations in an in vivo model. In addition, it has a potent antilipolytic effect when administered IV, an effect likely mediated by stimulation of insulin secretion. The observation that systemic FFA oxidation was only paon that systemic FFA oxidation was only partially suppressed at this relatively high dose of MP is consistent with previous studies suggesting that MP may exert its major effect in the liver, and may be less potent in extrahepatic tissues

262

Intravenous immunoglobulin treatment in patients with chronic inflammatory demyelinating polyneuropathy.  

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Intravenous immunoglobulin (IVIg) treatment is shown to be effective in a selected group of patients with a chronic inflammatory demyelinating polyneuropathy (CIDP). The proportion of patients that improve after IVIg treatment varies between studies. Because 40% of a group of IVIg treated CIDP patients needed intermittent IVIg infusions to maintain their improved clinical condition, it is expected that IVIg is effective, at least in this subgroup of patients. However, the proportion of patien...

Doorn, P. A.

1994-01-01

263

Superselective arterial infusion and concomitant radiotherapy  

Energy Technology Data Exchange (ETDEWEB)

Superselective arterial infusion for patients with advanced head and neck cancer has been increasingly applied in Japan. We analyzed our experiences and evaluated the efficacy and safety of this treatment. Through October 1999 to March 2002, 29 patients, ranging in age between 33 and 71 years (median 52 years), received superselective intra-arterial infusion therapy of cisplatin (100-120 mg/m{sup 2}/week) with simultaneous intravenous infusion of thiosulfate for neutralizing cisplatin toxicity, and conventional concomitant extrabeam radiotherapy (65 Gy/26 f/6.5 weeks). Four patients were diagnosed with stage III and 25 with stage IV. Thirteen patients were considered contraindicated for surgery, and the other 16 patients rejected radical surgery. Primary tumor sites included paranasal sinus (11 patients), hypopharynx (7), oropharynx (6), oral cavity (4), and parotid gland (1). During the median follow-up period of 20 months, there was no apparent recurrence in 14 (48.3%) of 29 patients. Eleven (37.9%) patients died of disease, and three (10.3%) were alive with disease. In twenty-one patients (72.4%) the primary lesions were well-controlled. Acute toxic effects were moderate, and severe toxic events occurred in four cases, namely, methicillin-resistant staphylococcus aureus (MRSA) pneumonia, sepsis, tetraplasia, and osteoradionecrosis. We confirmed the effectiveness and safety of superselective arterial infusion and concomitant radiotherapy. Furthermore, we must establish the optimal procedures and schedule, as well as the indications for this treatment. This treatment protocol may improve the prognosis of patients with unresectable disease and patients rejecting surgical treatment. Further study in this particular area is needed. (author)

Homma, Akihiro; Suzuki, Fumiyuki; Inuyama, Yukio; Fukuda, Satoshi [Hokkaido Univ., Sapporo (Japan). School of Medicine

2003-05-01

264

Insulin receptor antibody-iduronate 2-sulfatase fusion protein: Pharmacokinetics, anti-drug antibody, and safety pharmacology in Rhesus monkeys.  

Science.gov (United States)

Mucopolysaccharidosis (MPS) Type II is caused by mutations in the gene encoding the lysosomal enzyme, iduronate 2-sulfatase (IDS). The majority of MPSII cases affect the brain. However, enzyme replacement therapy with recombinant IDS does not treat the brain, because IDS is a large molecule drug that does not cross the blood-brain barrier (BBB). To enable BBB penetration, IDS has been re-engineered as an IgG-IDS fusion protein, where the IgG domain is a monoclonal antibody (MAb) against the human insulin receptor (HIR). The HIRMAb crosses the BBB via receptor-mediated transport on the endogenous BBB insulin receptor, and the HIRMAb domain of the fusion protein acts as a molecular Trojan horse to ferry the fused IDS into brain from blood. The present study reports on the first safety pharmacology and pharmacokinetics study of the HIRMAb-IDS fusion protein. Juvenile male Rhesus monkeys were infused intravenously (IV) weekly for 26 weeks with 0, 3, 10, or 30?mg/kg of the HIRMAb-IDS fusion protein. The plasma clearance of the fusion protein followed a linear pharmacokinetics profile, which was equivalent either with measurements of the plasma concentration of immunoreactive HIRMAb-IDS fusion protein, or with assays of plasma IDS enzyme activity. Anti-drug antibody (ADA) titers were monitored monthly, and the ADA response was primarily directed against the variable region of the HIRMAb domain of the fusion protein. No infusion related reactions or clinical signs of immune response were observed during the course of the study. A battery of safety pharmacology, clinical chemistry, and tissue histopathology showed no signs of adverse events, and demonstrate the safety profile of chronic treatment of primates with 3-30?mg/kg weekly IV infusion doses of the HIRMAb-IDS fusion protein. Biotechnol. Bioeng. 2014;111: 2317-2325. © 2014 Wiley Periodicals, Inc. PMID:24889100

Boado, Ruben J; Ka-Wai Hui, Eric; Zhiqiang Lu, Jeff; Pardridge, William M

2014-11-01

265

Systemic and regional hemodynamic effects of enalaprilat infusion in experimental normotensive sepsis  

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Angiotensin-converting enzyme inhibitors have been shown to improve splanchnic perfusion in distinct shock states. We hypothesized that enalaprilat potentiates the benefits of early fluid resuscitation in severe experimental sepsis, particularly in the splanchnic region. Anesthetized and mechanically ventilated mongrel dogs received an intravenous infusion of live Escherichia coli over a period of 30 min. Thereafter, two interventions were performed: fluid infusion (normal saline, 32 mL/kg ov...

Rahal L.; Garrido A.G.; Cruz Jr. R.J.; Rocha e Silva M.; Poli-de-Figueiredo L.F.

2006-01-01

266

Lipolytic response to glucose infusion in human subjects  

International Nuclear Information System (INIS)

The authors have determined the effect of various rates of glucose infusion on the rates of release of glycerol (R/sub a/ glycerol), free fatty acids (R/sub a/ FFA), and on energy metabolism in normal human volunteers. Plasma kinetics were determined with use of the stable isotopic tracers D-5-glycerol and [1-13C]palmitate, and energy metabolism was determined by indirect calorimetry. The effect of glucose infusion on R/sub a/ glycerol and R/sub a/ FFA was dose-dependent. At 4 mg x kg-1 x min-1, both R/sub a/ glycerol and R/sub a/ FFA were suppressed; at 8 mg x kg-1 x min-1, R/sub a/ FFA was even more depressed, but R/sub a/ glycerol was similar to the value during the 4 mg x kg-1 x min-1 infusion. At all infusion rates tested, the amount of potential energy available from the sum of the glucose infusion and endogenously mobilized fat was always greater than when no glucose was infused. Glucose decreased fat mobilization by both inhibiting lipolysis and stimulating reesterification, thus causing a significant increase in triglyceride-fatty acid substrate cycling within the adipose tissue. Plasma insulin was determined by radioimmunoassay

267

Prediction of the insulin sensitivity index using Bayesian networks  

DEFF Research Database (Denmark)

The insulin sensitivity index () can be used in assessing the risk of developing type 2 diabetes. An intravenous study is used to determine using Bergmans minimal model. However, an intravenous study is time consuming and expensive and therefore not suitable for large scale epidemiological studies. In this paper we learn the parameters and structure of several Bayesian networks relating measurements from an oral glucose tolerance test to the insulin sensitivity index determined from an intravenous study on the same individuals. The networks can then be used in prediction of from an oral glucose tolerance test instead of an intravenous study. The methodology is applied to a dataset with 187 patients. We find that the values from this study are highly correlated to the values determined from the intravenous study. S_I S_I S_I S_I S_I

BØttcher, Susanne Gammelgaard; Dethlefsen, Claus

2004-01-01

268

Human Models of Low-Grade Inflammation: Bolus versus Continuous Infusion of Endotoxin?  

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Systemic low-grade inflammation is recognized in an increasing number of chronic diseases. With the aim of establishing an experimental human in vivo model of systemic low-grade inflammation, we measured circulating inflammatory mediators after intravenous administration of Escherichia coli endotoxin (0.3 ng/kg of body weight) either as a bolus injection or as a 4-h continuous intravenous infusion, as well as after saline administration, in 10 healthy male subjects on three separate study day...

Taudorf, S.; Krabbe, K. S.; Berg, R. M. G.; Pedersen, B. K.; Møller, K.

2007-01-01

269

Mapping brain c-Fos immunoreactivity after insulin-induced voluntary lard intake: insulin- and lard-associated patterns.  

Science.gov (United States)

In addition to the inhibitory role of central insulin on food intake, insulin also acts to promote lard intake. We investigated the neural pathways involved in this facet of insulin action. Insulin or saline was infused into either the superior mesenteric or right external jugular veins of streptozotocin-diabetic rodents with elevated steady-state circulating corticosterone concentrations. After postsurgical recovery, rats were offered the choice of chow or lard to eat. Irrespective of the site of venous infusion, insulin increased lard and decreased chow intake. After 4 days, lard was removed for 8 h. On return for 1 h, only insulin infused into the superior mesenteric vein resulted in lard intake. This facilitated distinction between the effects of circulating insulin concentrations (similar in the two insulin-infused groups) and lard ingestion on the patterns of c-Fos(+) cells in the brain, termed insulin- and lard-associated patterns, respectively. Insulin-associated changes in c-Fos(+) cell numbers were evident in the arcuate nucleus, bed nucleus of the stria terminalis and substantia nigra pars compacta, concomitant with elevated leptin levels and reduced chow intake. Lard-associated changes in c-Fos(+) cell numbers were observed in the nucleus of the tractus solitarius, lateral parabrachial nucleus, central nucleus of the amygdala, ventral tegmental area, nucleus accumbens shell and the prefrontal cortex, and were associated with lower levels of triglycerides and free fatty acids. The anterior paraventricular thalamic nucleus exhibited both patterns. These data collectively fit into a framework for food intake and reward and provide targets for pharmacological manipulation to influence the choice of food intake. PMID:17850462

Warne, J P; Horneman, H F; Ginsberg, A B; Pecoraro, N C; Foster, M T; Akana, S F; Dallman, M F

2007-10-01

270

Insulin Injection  

Science.gov (United States)

... of insulin. Always use the same brand and model of needle and syringe. Ask your doctor or ... pituitary (a small gland in the brain), thyroid, liver, or kidney disease.tell your doctor if you are pregnant, plan ...

271

Update on intravenous dipyridamole cardiac imaging in the assessment of ischemic heart disease  

International Nuclear Information System (INIS)

Intravenous dipyridamole is a relative selective coronary vasodilator which, when combined with thallium-201, provides a useful technique to assess myocardial perfusion. The intravenous dipyridamole is administered as an infusion at a rate of 0.14 mg/kg/min for 4 minutes. In the presence of significant coronary artery disease the increase of coronary blood flow is disproportionate between vessels with and without significant coronary lesions, providing the basis for detecting regional differences in flow using thallium-201. The test can be used alone or combined with low level exercise to increase test sensitivity. The test is safe when performed under medical supervision and when patient selection is done appropriately. Most of the side effects induced by dipyridamole infusion are well tolerated by patients and readily reversed with intravenous aminophylline and sublingual nitroglycerin. The average sensitivity and specificity of the dipyridamole thallium scintigraphy test from the major studies are 76% and 70%, respectively. The test is very useful in providing prognostic information in patients who are unable to exercise. A reversible thallium defect after dipyridamole infusion has been shown to be associated with significant mortality and morbidity in patients with documented or suspected coronary artery disease. The use of intravenous dipyridamole has been extended into other modalities of imaging, including 2-dimensional and Doppler echocardiography, to study functional changes in the left ventricular induced by the infusion of intravenous dipyridamole. 52 references

272

Insulin receptor has tyrosine kinase activity toward Shc in rat liver  

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Full Text Available Insulin induces tyrosine phosphorylation of Shc in cell cultures and in insulin-sensitive tissues of the intact rat. However, the ability of insulin receptor (IR tyrosine kinase to phosphorylate Shc has not been previously demonstrated. In the present study, we investigated insulin-induced IR tyrosine kinase activity towards Shc. Insulin receptor was immunoprecipitated from liver extracts, before and after a very low dose of insulin into the portal vein, and incubated with immunopurified Shc from liver of untreated rats. The kinase assay was performed in vitro in the presence of exogenous ATP and the phosphorylation level was quantified by immunoblotting with antiphosphotyrosine antibody. The results demonstrate that Shc interacted with insulin receptor after infusion of insulin, and, more important, there was insulin receptor kinase activity towards immunopurified Shc. The description of this pathway in animal tissue may have an important role in insulin receptor tyrosine kinase activity toward mitogenic transduction pathways.

Páez-Espinosa E.V.

1998-01-01

273

High alanine aminotransferase is associated with decreased hepatic insulin sensitivity and predicts the development of type 2 diabetes  

DEFF Research Database (Denmark)

It has been proposed that liver dysfunction may contribute to the development of type 2 diabetes. The aim of the present study was to examine whether elevated hepatic enzymes (alanine aminotransferase [ALT], aspartate aminotransferase [AST], or gamma -glutamyltranspeptidase [GGT]) are associated with prospective changes in liver or whole-body insulin sensitivity and/or insulin secretion and whether these elevated enzymes predict the development of type 2 diabetes in Pima Indians. We measured ALT, AST, and GGT in 451 nondiabetic (75-g oral glucose tolerance test) Pima Indians (aged 30 +/- 6 years, body fat 33 +/- 8%, ALT 45 +/- 29 units/l, AST 34 +/- 18 units/l, and GGT 56 +/- 40 units/l [mean +/- SD]) who were characterized for body composition (hydrodensitometry or dual-energy X-ray absorptiometry), whole-body insulin sensitivity (M), and hepatic insulin sensitivity (hepatic glucose output [HGO] during the low-dose insulin infusion of a hyperinsulinemic clamp) and acute insulin response (AIR) (25-g intravenous glucose challenge). Sixty-three subjects developed diabetes over an average follow-up of 6.9 +/- 4.9 years. In 224 subjects, who remained nondiabetic, follow-up measurements of M and AIR were available. At baseline, ALT, AST, and GGT were related to percent body fat (r = 0.16, 0.17, and 0.11, respectively), M (r = -0.32, - 0.28, and -0.24), and HGO (r = 0.27, 0.12, and 0.14; all P <0.01). In a proportional hazard analysis with adjustment for age, sex, body fat, M, and AIR, higher ALT [relative hazard 90th vs. 10th centiles (95% CI): 1.9 (1.1-3.3), P = 0.02], but not AST or GGT, predicted diabetes. Elevated ALT at baseline was associated prospectively with an increase in HGO (r = 0.21, P = 0.001) but not with changes in M or AIR (both P = 0.1). Higher ALT concentrations were cross-sectionally associated with obesity and whole-body and hepatic insulin resistance and prospectively associated with a decline in hepatic insulin sensitivity and the development of type 2 diabetes. Our findings indicate that high ALT is a marker of risk for type 2 diabetes and suggest a potential role of the liver in the pathogenesis of type 2 diabetes.

Vozarova, Barbora; Stefan, Norbert

2002-01-01

274

What´s cheapest, intravenous iron sucrose- or intravenous iron carboxymaltose treatment in IBD patients? : It dependent on the economic evaluation perspective!  

DEFF Research Database (Denmark)

  What´s cheapest, intravenous iron sucrose- or intravenous iron carboxymaltose treatment in IBD patients? It dependent on the economic evaluation perspective!   Aim: To evaluate the health care cost for intravenous iron sucrose (Venofer®, Vifor) and intravenous iron carboxymaltose (Ferinject®, Vifor) treatment to IBD patients in an outpatient setting.   Background: Intravenous iron sucrose can be given as a maximum of 200 mg Fe++ per infusion vs. intravenous iron carboxymaltose that can be given as a maximum of 1000 mg Fe++ in a single infusion leading to fewer infusions and visits. The drug-cost per mg iron is for iron carboxymaltose approximately double the cost of iron sucrose.   Patients and Methods: Data related to 111 IBD-patients treated with intravenous iron at Aarhus University Hospital from August 2005 until October 2009 was used for the economic evaluation. Analysis included a Budget Impact Analysis (BIA) from a hospital perspective, a Cost Effective Analysis (CEA) from a patient perspective and a Cost Benefit Analysis (CBA) consecutively including 20 IBD patients' willingness-to-pay' (WTP) assessment. BIA and CEA analysis were based on total infusion-doses from 500 mg Fe++ till 1600 mg Fe++. The WTP analysis was based on a total infusion-dose at 1400 mg Fe++. The evaluations are analysed assuming that the effect parameter (quantity of iron delivered) is comparable regardless of the iron formulation given intravenously.   Results: The BIA including price for drug, utensils and ½ hour spend by a nurse per visit; showed approximately 150€ extra cost per 1000 mg Fe++ administrated, if iron carboxymaltose was chosen. In contrast the CEA including both BIA-values and patient-related costs (transportation and lost income) showed iron carboxymaltose to be more cost-effective than iron sucrose, due to fewer outpatient setting visits. As IBD-patients could have less income as the average of the background population due to disease activity, sensitivity analysis using a 50% income level weredone, showing the same tendency but less significant. The average patients WTP for a total of iron-dose was to 233€ to reduce the numbers of infusion from 7 till 2.    Conclusion: The cost of choosing iron carboxymaltose rather than iron sucrose in treatment of iron deficiency in IBD differs depending of the economic perspective chosen. Only the Budget Impact Analysis showed iron sucrose to be the cheapest. If the patients' perspective is included in the economic evaluation iron carboxymaltose is the most cost-effective.

Bager, Palle; Dahlerup, Jens Frederik

275

Racl Signaling Is Required for Insulin-Stimulated Glucose Uptake and Is Dysregulated in Insulin-Resistant Murine and Human Skeletal Muscle  

DEFF Research Database (Denmark)

The actin cytoskeleton-regulating GTPase Racl is required for insulin-stimulated GLUT4 translocation in cultured muscle cells. However, involvement of Racl and its downstream signaling in glucose transport in insulin-sensitive and insulin-resistant mature skeletal muscle has not previously been investigated. We hypothesized that Racl and its downstream target, p21-activated kinase (PAK), are regulators of insulin-stimulated glucose uptake in mouse and human skeletal muscle and are dysregulated in insulin-resistant states. Muscle-specific inducible Racl knockout (KO) mice and pharmacological inhibition of Racl were used to determine whether Racl regulates insulin-stimulated glucose transport in mature skeletal muscle. Furthermore, Racl and PAK1 expression and signaling were investigated in muscle of insulin-resistant mice and humans. Inhibition and KO of Racl decreased insulin-stimulated glucose transport in mouse soleus and extensor digitorum longus muscles ex vivo. Had KO mice showed decreased insulin and glucose tolerance and trended toward higher plasma insulin concentrations after intraperitoneal glucose injection. Racl protein expression and insulin-stimulated PAK(Thr423) phosphorylation were decreased in muscles of high fat-fed mice. In humans, insulin-stimulated FAX activation was decreased in both acute insulin-resistant (intralipid infusion) and chronic insulin-resistant states (obesity and diabetes). These findings show that Racl is a regulator of insulin-stimulated glucose uptake and a novel candidate involved in skeletal muscle insulin resistance.

Hojlund, K.

2013-01-01

276

Safe insulin use in the hospital setting.  

Science.gov (United States)

Inpatients have a high rate of diabetes (12%-26%) and hyperglycemia (~38%). All patients should have their glycosylated hemoglobin (A1C) checked on admission to help differentiate between long-term and new-onset hyperglycemia. Good glycemic control throughout the hospital stay is associated with decreases in short- and long-term risk of mortality, inpatient complications, length of hospital stay, and health care costs. Insulin is first-line therapy for hyperglycemia; patients with hyperglycemia should be managed using either intravenous (IV) or subcutaneous (SC) insulin algorithms. A hypoglycemia management protocol should be in place at the hospital for safety purposes. For successful glycemic control, insulin algorithms should have dynamic scales, require frequent glucose monitoring, and be simple and easy to use. The algorithm should address transitioning patients from IV to SC insulin and a discharge plan. Insulin analogues are preferred for basal, mealtime, and correction doses instead of human insulins (regular and NPH) because analogues have a more predictable absorption and action profile and less pharmacokinetic fluctuation. Institutions can increase safe insulin use by utilizing insulin algorithms, preprinted order sets, and hypoglycemia protocols; by supporting patient and health care provider education; and by implementing needle-stick prevention techniques. PMID:20877171

Schmeltz, Lowell R

2009-12-01

277

Clinical evaluation of glucagon and insulin in therapy of fulminant hepatitis.  

Science.gov (United States)

Forty five patients were examined in order to evaluate the usefulness of glucagon and insulin as a therapy of fulminant hepatitis. Thirty patients were treated with simultaneous infusion of glucagon and insulin, whereas prednisolone was given at a daily dose of 60 to 90 mg in 15 cases. In the former group, 1 mg of glucagon and 10 units of regular insulin were infused over a period of 2 to 6 hours. Two such treatments were given per day in the early critical period of fulminant hepatitis. The therapeutic effect of glucagon and insulin was evaluated in comparison with that of prednisolone, and additionally, with a combination therapy of either blood exchange or plasmapheresis in both groups. The survival rate was superior in the group treated with glucagon and insulin (46%) and in the one with combined infusion of these hormones plus plasmapheresis (33%). PMID:3315819

Okita, K; Matsuda, S; Hanta, T; Yasunaga, M; Sanuki, K; Takemoto, T

1987-10-01

278

Glucose-stimulated insulin secretion causes an insulin-dependent nitric oxide-mediated vasodilation in the blood supply of the rat sciatic nerve.  

Science.gov (United States)

This study tested the hypothesis that acute hyperglycemia reduces sciatic nerve blood flow in Sprague-Dawley rats. Anesthetized rats underwent cannulation of their right jugular vein (for anesthetic/nutrient/drug infusion) and right carotid artery (for continuous blood pressure measurement via pressure transducer). The left sciatic nerve was exposed and nerve blood velocity (NBV) was assessed from an arterial segment lying superficially along the sciatic nerve (Doppler ultrasound, 40 MHz). NBV and mean arterial pressure (MAP) values were collected, and an index of nerve vascular conductance (NVC) was established (NBV/MAP) at baseline and at 5, 10, 20, and 30 min (and 80 min for insulin) following 1) low glucose infusion, 1 g/kg (50% solution); 2) high glucose infusion, 3 g/kg; 3) high glucose infusion in the absence of a functioning pancreas; 4) euglycemic hyperinsulinemic clamp-insulin infusion (10 mU·kg?¹·min?¹; 0.4 IU/ml); 5) high glucose infusion + NG-nitro-L-arginine methyl ester (L-NAME) infusion (30 mg/kg); and 6) L-NAME alone followed 20 min later by high glucose infusion. High glucose infusion increased NVC by ~120% relative to baseline (P < 0.001), and this dilation was attenuated in rats without a functioning pancreas (i.e., without insulin secretion) (P = 0.004) and following L-NAME infusion (P = 0.011). Therefore, the vasodilation in rat sciatic nerve during glucose infusion was dependent upon the insulin response and acted through a nitric oxide synthase pathway. PMID:23616106

Olver, T Dylan; Mattar, Louis; Grisé, Kenneth N; Twynstra, Jasna; Noble, Earl G; Lacefield, James C; Shoemaker, J Kevin

2013-07-15

279

Actions of prolonged ghrelin infusion on gastrointestinal transit and glucose homeostasis in humans  

DEFF Research Database (Denmark)

Ghrelin is produced by enteroendocrine cells in the gastric mucosa and stimulates gastric emptying in healthy volunteers and patients with gastroparesis in short-term studies. The aim of this study was to evaluate effects of intravenous ghrelin on gastrointestinal motility and glucose homeostasis during a 6-h infusion in humans.

Falkén, Y; Hellström, P M

2010-01-01

280

Pharmacokinetics of insulin lispro in type 2 diabetes during closed-loop insulin delivery.  

Science.gov (United States)

Insulin pharmacokinetics is not well understood during continuous subcutaneous insulin infusion in type 2 diabetes (T2D). We analyzed data collected in 11 subjects with T2D [6 male, 9 white European and two of Indian ethnicity; age 59.7(12.1) years, BMI 30.1(3.9)kg/m(2), fasting C-peptide 1002.2(365.8)pmol/l, fasting plasma glucose 9.6(2.2)mmol/l, diabetes duration 8.0(6.2) years and HbA1c 8.3(0.8)%; mean(SD)] who underwent a 24-h study investigating closed-loop insulin delivery at the Wellcome Trust Clinical Research Facility, Cambridge, UK. Subcutaneous delivery of insulin lispro was modulated every 15min according to a model predictive control algorithm. Two complementary insulin assays facilitated discrimination between exogenous (lispro) and endogenous plasma insulin concentrations measured every 15-60min. Lispro pharmacokinetics was represented by a linear two-compartment model whilst parameters were estimated using a Bayesian approach applying a closed-form model solution. The time-to-peak of lispro absorption (tmax) was 109.6 (75.5-120.5)min [median (interquartile range)] and the metabolic clearance rate (MCRI) 1.26 (0.87-1.56)×10(-2)l/kg/min. MCRI was negatively correlated with fasting C-peptide (rs=-0.84; P=.001) and with fasting plasma insulin concentration (rs=-0.79; P=.004). In conclusion, compartmental modelling adequately represents lispro kinetics during continuous subcutaneous insulin infusion in T2D. Fasting plasma C-peptide or fasting insulin may be predictive of lispro metabolic clearance rate in T2D but further investigations are warranted. PMID:25092225

Ruan, Yue; Thabit, Hood; Kumareswaran, Kavita; Hovorka, Roman

2014-11-01

 
 
 
 
281

Sup(13)C NMR studies of glucose disposal in normal and non-insulin-dependent diabetic humans  

Energy Technology Data Exchange (ETDEWEB)

To examine the extent to which the defect in insulin action in subjects with non-insulin-dependent diabetes mellitus (NIDDM) can be accounted for by impairment of muscle glycogen synthesis, we performed combined hyperglycemic-hyperinsulinemic clamp studies with ({sup 13}C)glucose in five subjects with NIDDM and in six age- and weight-matched healthy subjects. The rate of incorporation of intravenously infused (1-{sup 13}C)glucose into muscle glycogen was measured directly in the gastrocnemius muscle by means of a nuclear magnetic resonance (NMR) spectrometer with a 15.5 min time resolution and a {sup 13}C surface coil. The steady-state plasma concentrations of insulin and glucose were similar in both study groups. The mean (+-SE) rate of glycogen synthesis, as determined by {sup 13}C NMR, was 78+-28 and 183+-39 {mu}mol-glucosyl units (kg muscle tissue (wet mass)){sup -1} min{sup -1} in the diabetic and normal subjects, respectively. The mean glucose uptake was markedly reduced in the diabetic as compared with the normal subjects. The mean rate of non-oxidative glucose metabolism was 22+-4 {mu}mol kg{sup -1} min{sup -1} in the diabetic subjects and 42+-4 {mu}mol kg{sup -1} min{sup -1} in the normal subjects. When these rates are extrapolated to apply to the whole body, the synthesis of muscle glycogen would account for most of the total-body glucose uptake and all of the non-oxidative glucose metabolism in both normal and diabetic subjects. We conclude that muscle glycogen synthesis is the principal pathway of glucose disposal in both normal and diabetic subjects and that defects in muscle glycogen synthesis have a dominant role in the insulin resistance that occurs in persons with NIDDM. (author).

Shulman, G.I.; Rothman, D.L.; Shulman, R.G. (Yale Univ., New Haven, CT (USA). School of Medicine)

1990-12-15

282

Sup(13)C NMR studies of glucose disposal in normal and non-insulin-dependent diabetic humans  

International Nuclear Information System (INIS)

To examine the extent to which the defect in insulin action in subjects with non-insulin-dependent diabetes mellitus (NIDDM) can be accounted for by impairment of muscle glycogen synthesis, we performed combined hyperglycemic-hyperinsulinemic clamp studies with [13C]glucose in five subjects with NIDDM and in six age- and weight-matched healthy subjects. The rate of incorporation of intravenously infused [1-13C]glucose into muscle glycogen was measured directly in the gastrocnemius muscle by means of a nuclear magnetic resonance (NMR) spectrometer with a 15.5 min time resolution and a 13C surface coil. The steady-state plasma concentrations of insulin and glucose were similar in both study groups. The mean (±SE) rate of glycogen synthesis, as determined by 13C NMR, was 78±28 and 183±39 ?mol-glucosyl units (kg muscle tissue (wet mass))-1 min-1 in the diabetic and normal subjects, respectively. The mean glucose uptake was markedly reduced in the diabetic as compared with the normal subjects. The mean rate of non-oxidative glucose metabolism was 22±4 ?mol kg-1 min-1 in the diabetic subjects and 42±4 ?mol kg-1 min-1 in the normal subjects. When these rates are extrapolated to apply to the whole body, the synthesis of muscle glycogen would account for most of the total-body glucose uptake and all of the non-oxidative glucose metabolism in both normal and diabetic subjects. We conclude that muscle glycogen synthesis is the principal pathway of glucose disposal in both normal and diabetic subjects and that defects in muscle glycogen synthesis have a dominant role in the insulin resistance that occurs in persons with NIDDM. (author)

283

Initial pharmacology and toxicology of intravenous desmethylmisonidazole  

Energy Technology Data Exchange (ETDEWEB)

Since January 1981, 52 patients have entered the Radiaton Therapy Oncology Group Phase I trial with intravenous (i.v.) desmethylmisonidazole (DMM). DMM is less lipophilic than misonidazole (MISO) and theoretically will be less neurotoxic due to lower penetration into neural tissue and more rapid elimination. The drug is administered intravenously to achieve the maximum drug concentration in tumor for a given dose. The protocol slowly escalates the total dose of drug administered. At this time the planned dose on the three week schedule is 1 g/m/sup 2/ twice weekly to a total dose of 17.5g/m/sup 2/. The preliminary plasma pharmacokinetic data demonstrates high peak plasma levels within five minutes of the end of the drug infusion. Compared to MISO the percent of DMM excreted in the urine is increased, 63% vs 10%, and the elimination half-life is decreased: DMM, i.v. 5.3h; MISO, i.v. 9.3h; MISO, oral 10 to 13h. Neurotoxicity has been observed in approximately 30% of patients given a cumulative dose of >11g/m/sup 2/. This is in comparison to a 50% incidence in RTOG Phase 1 study with oral MISO at doses of 12g/m/sup 2/. There is not sufficient data to evaluate the relationship between neurotoxicity and drug exposure. Further patient accrual on this study is required to better define the properties of DMN.

Coleman, C.N. (Stanford Univ., CA); Wasserman, T.H.; Phillips, T.L.; Strong, J.M.; Urtasun, R.C.; Schwade, J.G.; Johnson, R.J.; Zagars, G.

1982-03-01

284

Effects of intravenous vasopressin on canine mesenteric arterial blood flow, bowel oxygen consumption, and cardiac output  

Energy Technology Data Exchange (ETDEWEB)

The effects of various doses of intravenous vasopressin on mesenteric arterial blood flow, intestinal oxygen consumption, and cardiac output in anesthetized dogs were investigated. Optimal dose rate of intravenous vasopressin was found to be 3.0 mU/kg/min. At this dose rate, mesenteric arterial blood flow, intestinal oxygen consumption, and cardiac output decreased by 57%, 57% and 26%, respectively. Increasing the dose rate to 8.0 mU/kg/min did not offer significant gains. Maximum effect was observed 20 min after the beginning of the infusion. The effects disappeared 10 to 20 min after the infusion was discontinued, with the exception of superior mesenteric blood flow which showed a rebound increase. We conclude that in the anesthetized dog, intravenous infusions of vasopressin at low dose rates (3.0 mU/kg/min) substantially reduce mesenteric blood flow and intestinal oxygen extraction with moderate reduction of cardiac output. Possible clinical applications of low dose intravenous infusions of vasopressin would include reduction of portal hypertension and bowel protection during radiation therapy.

Athanasoulis, C.A.; Waltman, A.C.; Simmons, J.T.; Sheehan, B.; Coggins, C.H.

1978-01-01

285

ADVERSE EFFECTS OF INTRAVENOUS IMMUNOGLOBULIN THERAPY IN PATIENTS WITH ANTIBODY DEFICIENCY  

Directory of Open Access Journals (Sweden)

Full Text Available Long-term intravenous immunoglobulin (IVIG infusion is an effective treatment for children with humoral immunodeficiencies, already be complicated by systemic ad¬verse effects. In order to determine the adverse effects of intravenous immunoglobulin inpatients with antibody deficiency, 45 immunodeficientpatients receiving intravenous immunoglobulin were studied during a 36-month period at Children's Medical Center. The investigated group included 25 patients with common variable immunodeficiency, 14 patients with X-linked agammaglobulinemia and 6 patients with IgG subclass defi¬ciency. A total of fifty adverse effects occurred through 955 infusions (5.2%. The most frequent immediate adverse effects were mild (40 infusions out of 955 in 22 cases, including: chills, flushing, fever, nausea and headache. Three patients experienced mod¬erate effects (10 infusions out of 955 such as rash, severe headache, joint pain and chest tightness. None of the effects was anaphylactic type. It can be concluded that intravenous immunoglobulin is generally a well-tolerated medical agent for patients with antibody deficiency, but all patients should be monitored by a physician who is familiar with its indications, risks, adverse effects and their appropriate management.

Akefeh Ahmadi Afshar

2003-07-01

286

Octreotide infusion or emergency sclerotherapy for variceal haemorrhage.  

Science.gov (United States)

To compare octreotide with injection sclerotherapy in the treatment of acute variceal haemorrhage, patients admitted with gastrointestinal bleeding and oesophageal varices confirmed by endoscopy were randomised to receive either emergency sclerotherapy with 3% sodium tetradecyl sulphate or octreotide (50 micrograms intravenous bolus plus 50 micrograms per h intravenous infusion for 48 h). At the end of the study period (48 h), the octreotide group also had sclerotherapy to obliterate the varices. 100 patients were recruited. Demographic features including the aetiology of portal hypertension and the Child-Pugh's grading of the two groups were similar. Bleeding was initially controlled in 90% of patients by emergency sclerotherapy and in 84% by octreotide infusion (95% confidence interval 0-19.5, p = 0.55). There were no significant differences between the two groups in early (within 48 h of randomisation) rebleeding (16% vs 14%), blood transfusion (3 units vs 3.5), hospital stay (5 days vs 6 days), or hospital mortality (27% vs 20%). No notable side-effects were associated with octreotide. We conclude that octreotide infusion and emergency sclerotherapy are equally effective in controlling variceal haemorrhage. PMID:8103145

Sung, J J; Chung, S C; Lai, C W; Chan, F K; Leung, J W; Yung, M Y; Kassianides, C; Li, A K

1993-09-11

287

Putting Brakes on Insulin Pump Infusion to Prevent Hypoglycemia  

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The author provides an analysis of the study published by Agrawal and colleagues, in this issue of Journal of Diabetes Science and Technology, which describes usage and effectiveness of the low glucose suspend feature that is integrated into the Medtronic Paradigm® Veo™ sensor-augmented pump system.

Cengiz, Eda

2011-01-01

288

Insulin infusion reduces hepatocyte growth factor in lean humans  

DEFF Research Database (Denmark)

OBJECTIVE: Plasma Hepatocyte Growth Factor (HGF) is significantly elevated in obesity and may contribute to vascular disease, metabolic syndrome or cancer in obese individuals. The current studies were done to determine if hyperinsulinemia increases plasma HGF. MATERIALS/METHODS: Twenty-two participants (10 women/12 men, BMI 20.6-34.5 kg/m(2), age 18-49 years) underwent a hyperinsulinemic euglycemic clamp with measurement of HGF at baseline and steady state. Relationships between baseline HGF, anthropometrics, triglycerides, liver enzymes, c-reactive protein and adiponectin were also evaluated. RESULTS: Fasting HGF was positively correlated (P

de Courten, Barbora; de Courten, Maximilian

2013-01-01

289

Effect of isotonic and hypotonic lactated ringer's solutions with dextrose intravenously administered to dehydrated heifers.  

Science.gov (United States)

To determine the effects of rapid infusion of essential fluids in a volume of hypotonic lactated Ringer's solution, the central venous pressure (CVP) and acid-base equilibrium were investigated in to mildly dehydrated heifers. Mild dehydration was induced in 9 Holstein heifers by withholding food and water until 7.0+/-5.7% of plasma volume had been lost. The heifers were randomly assigned to the ILG (lactated Ringer's + 5% dextrose), HLG (1/2 lactated Ringer's + 2.2% dextrose) or HRG (1/2 Ringer's + 2.5% dextrose) groups with 3 heifers in each group. Heifers received 30 ml/kg of one of the fluids, at a flow rate of 20 ml/kg/hr. The rapid intravenous (IV) infusions of HLG and HRG used in this study were found to be safe and effective in increasing plasma volume without increasing CVP, even though the infusion was given to the jugular vein at a dosage of 30 ml/kg. However, ILG infusion induced progressive increases in CVP, reaching 9.0+/-2.0 mmHg. No clinical signs, such as moist rales on auscultation, moist cough, jugular vein congestion, ophthalmoptosis, salivation or arrhythmia, were observed throughout the fluid infusion. The relative changes in base excess (rBE) for the ILG and HRG groups were significantly decreased until the end of fluid infusion. As for the HLG group, rBE slightly decreased until the end of the fluid infusion. Then the values significantly increased and exceeded the pre-infusion value at the end of the experiment. While IV infusion of HLG inhibited acidification caused by dilution, HRG infusion induced diluted acidification. It is suggested that HLG infusion should be examined as a treatment for cattle with dehydration and moderate metabolic acidosis, since rapid infusion of HLG may be more beneficial for rehydrating cattle with metabolic acidosis than current treatment. PMID:12014579

Suzuki, Kazuyuki; Okumura, Junko; Abe, Izumi; Iwabuchi, Shigehiro; Kanayama, Kiichi; Asano, Ryuji

2002-04-01

290

[Development of smart infusion system].  

Science.gov (United States)

The free care smart infusion system which has the function of liquid end alarm and automatic stopping has been designed. In addition, the system can send the alarm to the health care staff by Zigbee wireless network. Besides, the database of infusion information has been set up, it can be used for inquiry afterwards. PMID:24839846

Li, Junyang

2014-01-01

291

Metabolic effects of chronic obestatin infusion in rats.  

Science.gov (United States)

Obestatin is purported to be a peptide hormone encoded in preproghrelin. We studied the metabolic effects of continuous infusion of obestatin via subcutaneously implanted osmotic mini-pumps. Administration of up to 500nmol/kg body weight/day obestatin did not change 24h cumulative food intake or body weight in rats. Similarly, no effects were observed when obestatin was infused at 1000nmol/kg body weight/day for seven days. This dose of obestatin infused during a 24h fast did not alter weight loss, suggesting that obestatin has no effect on energy expenditure, and this dose did not alter glucose or insulin responses during an IPGTT. Obestatin was originally proposed to interact with GPR39 and subsequently the receptor for GLP-1. While both receptors are expressed in pancreatic islets, incubation with obestatin did not alter insulin release from islets in vitro. Moreover, obestatin did not bind to INS-1 beta-cells or HEK cells overexpressing GLP-1 receptors or displace GLP-1 binding to these cells. Our findings do not support the concept that obestatin is a hormone with metabolic actions. PMID:18508160

Unniappan, Suraj; Speck, Madeleine; Kieffer, Timothy J

2008-08-01

292

Hepatic and muscle insulin action during late pregnancy in the dog  

Digital Repository Infrastructure Vision for European Research (DRIVER)

We evaluated the effects of physiologic increases in insulin on hepatic and peripheral glucose metabolism in nonpregnant (NP) and pregnant (P; 3rd trimester) conscious dogs (n = 9 each) using tracer and arteriovenous difference techniques during a hyperinsulinemic euglycemic clamp. Insulin was initially (?150 to 0 min) infused intraportally at a basal rate. During 0–120 min (Low Insulin), the rate was increased by 0.2 mU·kg?1·min?1, and from 120 to 240 min (High Insulin) insulin was...

Connolly, Cynthia C.; Papa, Tracy; Smith, Marta S.; Lacy, D. Brooks; Williams, Phillip E.; Moore, Mary Courtney

2007-01-01

293

Interactions of glucagon and free fatty acids with insulin in control of glucose metabolism  

International Nuclear Information System (INIS)

To study the interactions of physiological glucagon and free fatty acids (FFA) concentrations with insulin in the control of glucose metabolism, we determined in normal subjects the response of endogenous glucose production (EGP) and glucose utilization (Rd) to a progressive and moderate increase of insulinemia in the presence of glucagon and FFA levels either decreased (somatostatin [SRIF] and insulin infusion, C test) or maintained to normal postabsorptive values isolated (SRIF + insulin + glucagon infusion, G test; SRIF + insulin + Intralipid infusion, IL test) or in association (SRIF + insulin + glucagon + Intralipid infusion, IL + G test). Compared with the C test, maintenance of glucagon level had only small and inconsistent effects on glucose Rd, but induced a shift to the right of the dose-response curve to insulin of EGP (apparent ED50: C test, 10.9 mU.L-1; G test, 15.2 mU.L-1). Intralipid infusion resulted, whether glucagon was substituted or not, in a near total suppression of the insulin-induced increase of glucose Rd (Rd at the end of the tests: C test, 6.13 +/- 0.85 mg.kg-1.min-1; G test, 7.29 +/- 0.87 mg.kg-1.min-1; IL test, 3.30 +/- 0.65 mg.kg-1.min-1; IL + G test, 3.57 +/- 0.42 mg.kg-1.min-1). In the absence of glucagon, substitution Intralipid infusion also antagonized the action of insulin on EGP. However, this effect was no longer apparent when glucagon was replaced (dose-response curve to insulin of EGP during the G and the IL + G test were comparable)

294

Insulin resistance syndrome in postmenopausal women with cardiological syndrome X.  

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OBJECTIVE--To determine whether postmenopausal women with cardiological syndrome X (chest pain and abnormal exercise electrocardiogram despite normal coronary angiography) exhibit disturbances in the full range of proposed components of the putative "insulin resistance syndrome". PATIENTS AND METHODS--20 postmenopausal women with syndrome X and 20 healthy controls each underwent measurement of insulin resistance (by minimal model analysis of the intravenous glucose tolerance test), lipid, lip...

Godsland, I. F.; Crook, D; Stevenson, J. C.; Collins, P.; Rosano, G. M.; Lees, B.; Sidhu, M.; Poole-wilson, P. A.

1995-01-01

295

Effects of alpha and beta adrenergic blockade on hepatic glucose balance before and after oral glucose. Role of insulin and glucagon.  

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In conscious dogs, phentolamine infusion significantly increased fasting portal vein insulin, glucagon, and decreased net hepatic glucose output and plasma glucose. Propranolol significantly decreased portal vein insulin, portal flow, and increased hepatic glucose production and plasma glucose. Phentolamine, propranolol, and combined blockade reduced glucose absorption after oral glucose. alpha, beta, and combined blockade abolished the augmented fractional hepatic insulin extraction after or...

Chap, Z.; Ishida, T.; Chou, J.; Michael, L.; Hartley, C.; Entman, M.; Field, J. B.

1986-01-01

296

Physical stability of insulin formulations.  

Science.gov (United States)

Insulin aggregation remains a fundamental obstacle to the long-term application of many insulin infusion systems. We here report the effects of physiologic and nonphysiologic compounds on the aggregation behavior of crystalline zinc insulin (CZI) solutions. Under conditions chosen to simulate the most severe that would be encountered in delivery systems (presence of air, continuous motion, and elevated temperature), both highly purified and regular CZI at 5 U/ml formed turbid gels in 5 days. At concentrations of 100 and 500 U/ml stability was increased with turbid gels forming at 12 and 15 days, respectively. Under identical conditions, 5 U/ml CZI formulations containing the physiologic surfactant lysophosphatidylcholine (0.02%) or the synthetic surfactants SDS (1%), Brij 35 (0.1%), Tween (0.01%), or Triton X (0.01%) retained a transmittance at 540 nm of greater than 96% for 67-150 days. These nonionic and ionic surfactants containing the hydrophobic group, CH3(CH2)N, with N = 7-16, remarkably stabilized CZI formulations while those lacking such groups demonstrated little or no effect. The alcohols glycerol (30-50%) and isopropanol (10-50%) were moderately effective stabilizers. Silicone rubber drastically accelerated aggregation in all but one formulation (1% SDS). Emphasis in this study was placed on the properties of 5-U/ml formulations. Controls run at higher concentrations indicated a positive correlation between concentration and stability. It was concluded that the aggregation of insulin into high-molecular-weight polymers may be inhibited by reducing the effective polarity of the solvent. In this regard, anionic and nonionic surfactants containing appropriately long hydrophobic groups demonstrated the greatest degree of stabilization. Finally, of all the medical grade materials likely to be used in pumps, silicone rubber is the most active in promoting insulin aggregation. PMID:6341125

Lougheed, W D; Albisser, A M; Martindale, H M; Chow, J C; Clement, J R

1983-05-01

297

Smart Infusion Pump: A boon to the Health Care Industry  

Directory of Open Access Journals (Sweden)

Full Text Available Main motive of any hospital or clinic is to provide the best patient care. Patient care can be drastically improved using electronic medical record. An electronic medical record (EMR is a computerized medical record created in an organization that delivers care, such as a hospital or physician's office. The costs of storage media, such as paper and film, per unit of information differ dramatically from that of electronic storage media. When paper records are stored in different locations, collating them to a single location for review by a health care provider is time consuming and complicated, whereas the process can be simplified with electronic records. When treating a patient another major thing is to monitor the drug or fluid administered to the patient. Better and safer drug delivery systems will be the one with automatic or an intelligent infusion pump system. Thus automatic intravenous infusion will efficiently reduce medication and administration error.

K.V. Padmaja#1 , Apoorva M. Kalgal

2013-06-01

298

Radionuclide assessment of the hepatic arterial chemotherapy infusion pump  

International Nuclear Information System (INIS)

Since 1982, physicians at the Medical College of Ohio, Toledo, have performed 38 hepatic intraarterial chemotherapy infusion pump implantations for palliative treatment of metastatic liver disease from various primary tumors of the gastrointestinal tract. Radionuclide hepatic arterial pump imaging has proved to be an extremely reliable, cost-effective, and uncomplicated method of evaluating the pump function and liver perfusion. Scanning can be performed both before and during chemotherapy administration. Furthermore, during the course of chemotherapy, CT and intravenous sulfur colloid imaging of the liver can be used to follow the effectiveness of the infusion. The chemotherapeutic program can then be modified accordingly. The exhibit includes an illustration of the technique and analysis of results

299

A comparative study of peripheral to central circulation delivery times between intraosseous and intravenous injection using a radionuclide technique in normovolemic and hypovolemic canines  

International Nuclear Information System (INIS)

Intraosseous infusion is considered a useful technique for administration of medications and fluids in emergency situations when peripheral intravascular access is unobtainable. This study examined the effectiveness of intraosseous infusion for delivery of substances to the central circulation. Central deliveries of a radionuclide tracer administered by the intraosseous and intravenous routes were evaluated during normovolemic and hypovolemic states. Intraosseous infusion achieved peripheral to central circulation transit times comparable to those achieved by the intravenous route. Analysis of variance revealed no statistically significant differences between the peripheral to central delivery times comparing intraosseous and intravenous administration. The results demonstrate that intraosseous infusion is a rapid and effective method of delivery to the central circulation and is an alternative method for intravascular access. This study also suggests that a radionuclide tracer is useful for the evaluation of transit times following intraosseous injection

300

Insulin resistance in septic rats - a study by the euglycemic clamp technique  

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Male Wistar rats weighing 250±30g were made septic by cecum ligation and perforation. Peripheral and hepatic sensitivity to insulin was assessed by the euglycemic glucose clamp technique with simultaneous [3H]glucose infusion. Hepatic glucose output was not suppressed by the insulin infusion in the septic rats in contrast with the controls. Glucose utilization by the peripheral tissues was not significantly different between the septic and control rats. Counterregulatory hormone levels were higher in the septic group. Our data suggest that the liver is the site of insulin resistance in the septic state

 
 
 
 
301

Phase I study of intravenous iododeoxyuridine as a clinical radiosensitizer  

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Twenty-four patients with locally advanced (19 patients) or metastatic (5 patients) tumors were treated in a Phase I study combining constant intravenous infusions of iododeoxyuridine (IUdR) and hyperfractionated radiation therapy. IUdR was given as a constant infusion for 12 hours/day for two separate 14-day infusion periods in most patients. The dose of IUdR was escalated from 250 to 1200 mg/m2/12-hour infusion in this study. The initial tumor volume was treated to 45 Gy/1.5 Gy BID/3 weeks followed by a cone-down boost to 20-25 Gy/1.25 Gy BID/2 weeks after a planned 2-week break. THe IUdR infusion preceded the initial and cone-down irradiation by 1 week. Local acute toxicity (within the radiation volume) was uncommon and few patients required an alteration of the planned treatment schedule. Two patients developed late local toxicity with one patient showing clinical signs of radiation hepatitis and another patient developing a large bowel obstruction that required surgical bypass. Dose-limiting systemic toxicity was confined to the bone marrow with moderate to severe thrombocytopenia developing on Day 10-14 of infusions at 1200 mg/m2/12 hours. Mild stomatitis and partial alopecia occurred in some patients at this dose level. No systemic skin toxicity was seen. Pharmacology studies revealed steady-state arterial plasma levels of IUdR of 1 to 8 X 10(-6) M over the dose range used. In vivo IUdR incorporation into tumors was studied in three patients with high-grade sarcomas using an anti-IUdR monoclonal antibody and immunohistochemistry and demonstrated incorporation in up to 50-70% of tumor cells. The preliminary treatment results, particularly in patients with unresectable sarcomas, are encouraging.

Kinsella, T.J.; Russo, A.; Mitchell, J.B.; Collins, J.M.; Rowland, J.; Wright, D.; Glatstein, E.

1985-11-01

302

Insulin sensitivity in long-living Ames dwarf mice.  

Science.gov (United States)

Long-living Ames dwarf mice (df/df) characterized by growth hormone (GH) deficiency are widely used in aging research because of their 40-60 % lifespan extension compared to normal (N) littermates. Importantly, these mice not only live longer but are also protected from age-related diseases including insulin resistance. Several studies demonstrate that df/df mice have enhanced insulin signaling in different insulin-sensitive tissues and suggest that this is a mechanism for extended lifespan. However, it is unknown whether the enhanced insulin signaling in df/df mice translates to improved insulin action on hepatic glucose production and tissue glucose uptake. We performed hyperinsulinemic-euglycemic clamps to assess tissue-specific insulin action in vivo for the first time in these small long-living dwarfs. Our results demonstrate that the glucose infusion rate required to maintain euglycemia was ?2-fold higher in df/df mice compared to N controls. Insulin-mediated glucose production was completely suppressed in dwarf mice, and stimulation of gastrocnemius and vastus muscle and adipose tissue glucose uptake was also enhanced in df/df mice (100, 86, and 65 %, respectively). These findings show that improved insulin signaling in df/df mice is associated with enhanced tissue-specific insulin action in vivo. This improved functionality of insulin action and glucose homeostasis may play a key role in promoting healthy aging and longer lifespan in df/df mice. PMID:25163655

Wiesenborn, Denise S; Ayala, Julio E; King, Emily; Masternak, Michal M

2014-10-01

303

Pharmacology and therapeutic efficacy of bleomycin administered by continuous infusion  

International Nuclear Information System (INIS)

A study was done at Memorial Hospital in which Bleomycin was given by continuous intravenous infusion to radiation therapy patients with a variety of far advanced unresectable malignant neoplastic diseases. Smaller doses than usual were administered initially, approximately 1/10 the dose that had been previously studied. The dose was gradually escalated when it was shown that there was no acute toxicity from the smaller dose. Bleomycin blood levels were measured by bioassay and pulmonary function was studied by measurement of total lung capacity and carbon monoxide diffusing capacity. In this study, therapeutic activity in cervix cancer appeared to be significantly better than in earlier studies by the same group of investigators. However, in vitro and animal studies in the author's own clinical pharmacologic studies support the logic of continuous intravenous administration in the effort to decrease pulmonary toxicity and to improve therapeutic effect

304

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

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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

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

2014-01-01

305

Hemodynamic effects of rapid and slow infusions of manganese chloride and gadolinium-DTPA in dogs  

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The acute hemodynamic effects of two paramagnetic contrast materials, manganese chloride and gadolinium-DTPA, were examined in dogs using ultrasonic dimension gauge crystals. Slow infusions (more than 15 minutes) of MnCl2 or Gd-DTPA via an infusion pump had no significant hemodynamic effects. When given in just over 1 minute, Gd-DTPA produced elevated left ventricular (LV) end diastolic pressure and minor dilation of the ventricle and slowed diastolic filling. MnCl2, given rapidly, reduced systemic vascular resistance, resulting in hypotension. With both agents, these side effects waned after 5-10 minutes. It is concluded that both Gd-DTPA and MnCl2 can be given safely in 0.1-mm/kg doses when administered as a slow, continuous infusion. Slow, intravenous infusion of Gd-DTPA or MnCl2 is likely to be tolerated well by even severely ill individuals

306

IPMC-assisted miniature disposable infusion pumps with embedded computer control  

Science.gov (United States)

For military applications, the availability of safe, disposable, and robust infusion pumps for intravenous fluid and drug delivery would provide a significant improvement in combat healthcare. To meet these needs, we have developed a miniature infusion prototype pump for safe and accurate fluid and drug delivery that is programmable, lightweight, and disposable. In this paper we present techniques regarding inter-digitated IPMCs and a scaleable IPMC that exhibits significantly improved force performance over the conventional IPMCs. The results of this project will be a low cost accurate infusion device that can be scaled from a disposable small volume liquid drug delivery patch to disposable large volume fluid resuscitation infusion pumps for trauma victims in both the government and private sectors of the health industry.

Vohnout, Sonia; Kim, Sang-Mun; Park, Il-Seok; Banister, Mark; Tiwari, Rashi; Kim, Kwang J.

2007-04-01

307

Arginine infusion increases peripheral plasma somatostatin in man.  

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A somatostatin (SRIF) radioimmunoassay is described, using an antiserum raised in rabbit, reacting more with SRIF-14 than -28. Glass tubes were employed for the assay because our tracer, 125I 1-Tyr-SRIF, was adsorbed to plastic (23% non specific binding). Vycor extraction was used, and following Sephadex G-50 chromatography, the plasma extract showed two forms, coeluting with SRIF-28 and -14. Fifteen healthy subjects, eight women and seven men, 21-39 years old, received an infusion of arginine chloride (2.38 mmol/kg) for 20 min, or saline. An immediate rise in plasma SRIF from the mean basal level at 2 min was shown. Maximal value was 24.0 +/- 3.0 pmol/l (P less than 0.01) after 10 min followed by a rapid descent towards the basal level after the infusion. A temporal relationship was observed between the SRIF, insulin and glucagon responses following arginine infusion, while the GH levels increased only after the SRIF levels had declined, indicating an inhibition of GH. This is further supported by the high degree of correlation (r = 0.87) between SRIF- and GH increments. It is suggested that plasma SRIF measurement during arginine infusion gives an estimate of the pancreatic SRIF releasing capacity. PMID:6148165

Skare, S; Hanssen, K F; Kriz, V; Torjesen, P A

1984-09-01

308

All about Insulin Resistance  

Science.gov (United States)

... type 2 diabetes and heart disease. What does insulin do? Insulin helps your body use glucose for ... prediabetes or diabetes. What raises your risk for insulin resistance? You are at risk if you • are ...

309

Safety and feasibility of countering neurological impairment by intravenous administration of autologous cord blood in cerebral palsy  

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Full Text Available Abstract Backgrounds We conducted a pilot study of the infusion of intravenous autologous cord blood (CB in children with cerebral palsy (CP to assess the safety and feasibility of the procedure as well as its potential efficacy in countering neurological impairment. Methods Patients diagnosed with CP were enrolled in this study if their parents had elected to bank their CB at birth. Cryopreserved CB units were thawed and infused intravenously over 10~20 minutes. We assessed potential efficacy over 6 months by brain magnetic resonance imaging (MRI-diffusion tensor imaging (DTI, brain perfusion single-photon emission computed tomography (SPECT, and various evaluation tools for motor and cognitive functions. Results Twenty patients received autologous CB infusion and were evaluated. The types of CP were as follows: 11 quadriplegics, 6 hemiplegics, and 3 diplegics. Infusion was generally well-tolerated, although 5 patients experienced temporary nausea, hemoglobinuria, or urticaria during intravenous infusion. Diverse neurological domains improved in 5 patients (25% as assessed with developmental evaluation tools as well as by fractional anisotropy values in brain MRI-DTI. The neurologic improvement occurred significantly in patients with diplegia or hemiplegia rather than quadriplegia. Conclusions Autologous CB infusion is safe and feasible, and has yielded potential benefits in children with CP.

Lee Young-Ho

2012-03-01

310

Randomized factorial trial of high-dose intravenous streptokinase, of oral aspirin and of intravenous heparin in acute myocardial infarction. ISIS (International Studies of Infarct Survival) pilot study.  

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619 patients with suspected acute myocardial infarction (MI) were randomized to receive either a high-dose short-term intravenous infusion of streptokinase (1.5 MU over one hour) or placebo. Using a '2 X 2 X 2 factorial' design, patients were also randomized to receive either oral aspirin (325 mg on alternate days for 28 days) or placebo, and separately randomized to receive either intravenous heparin (1000 IU h-1 for 48 hours) or no heparin. Streptokinase (SK) was associated with a nonsignif...

Collins, R.

1987-01-01

311

Therapeutics of Diabetes Mellitus: Focus on Insulin Analogues and Insulin Pumps  

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Full Text Available Aim. Inadequately controlled diabetes accounts for chronic complications and increases mortality. Its therapeutic management aims in normal HbA1C, prandial and postprandial glucose levels. This review discusses diabetes management focusing on the latest insulin analogues, alternative insulin delivery systems and the artificial pancreas. Results. Intensive insulin therapy with multiple daily injections (MDI allows better imitation of the physiological rhythm of insulin secretion. Longer-acting, basal insulin analogues provide concomitant improvements in safety, efficacy and variability of glycaemic control, followed by low risks of hypoglycaemia. Continuous subcutaneous insulin infusion (CSII provides long-term glycaemic control especially in type 1 diabetic patients, while reducing hypoglycaemic episodes and glycaemic variability. Continuous subcutaneous glucose monitoring (CGM systems provide information on postprandial glucose excursions and nocturnal hypo- and/or hyperglycemias. This information enhances treatment options, provides a useful tool for self-monitoring and allows safer achievement of treatment targets. In the absence of a cure-like pancreas or islets transplants, artificial “closed-loop” systems mimicking the pancreatic activity have been also developed. Conclusions. Individualized treatment plans for insulin initiation and administration mode are critical in achieving target glycaemic levels. Progress in these fields is expected to facilitate and improve the quality of life of diabetic patients.

Vasiliki Valla

2010-01-01

312

Insulin partially reverses deficits in peripheral nerve blood flow and conduction in experimental diabetes.  

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Decreased nerve blood flow may be a pathogenetic factor in diabetic neuropathy. Previously it was shown that insulin treatment, commenced at the onset of streptozotocin-diabetes, prevents the development of a nerve blood flow deficit in the diabetic rat. The present study sought to determine the effect of short-term (one month) and acute (one hour) insulin reversal treatment on nerve blood flow deficits in streptozotocin-diabetes. Sciatic nerve blood flow was assessed using laser Doppler flowmetry. Treatment was initiated after one month of diabetes. One month of reversal insulin treatment ameliorated nerve laser Doppler flux (NDF) deficits; in untreated diabetic rats NDF was 51% of that in control animals (P insulin-treated diabetic rats NDF was 85% of control values (P resistance to hypoxic conduction block. Insulin partially reversed hyperglycaemia and sciatic nerve polyol and sugar levels. In a second experiment, in rats with one month of diabetes, acute infusion of insulin led to a 47% (P insulin values) reduction of plasma glucose. This fall in plasma glucose was accompanied by a 38% (P insulin values) increase in NDF. Sensory nerve conduction velocity was marginally increased (6%, P insulin values) after insulin infusion, but motor conduction velocity was not. The data indicate that insulin can partially reverse deficits in nerve blood flow and conduction in diabetic rats. PMID:8866422

Biessels, G J; Stevens, E J; Mahmood, S J; Gispen, W H; Tomlinson, D R

1996-09-01

313

Clinical utility of insulin and insulin analogs.  

Science.gov (United States)

Diabetes is a pandemic disease characterized by autoimmune, genetic and metabolic abnormalities. While insulin deficiency manifested as hyperglycemia is a common sequel of both Type-1 and Type-2 diabetes (T1DM and T2DM), it does not result from a single genetic defect--rather insulin deficiency results from the functional loss of pancreatic ? cells due to multifactorial mechanisms. Since pancreatic ? cells of patients with T1DM are destroyed by autoimmune reaction, these patients require daily insulin injections. Insulin resistance followed by ? cell dysfunction and ? cell loss is the characteristics of T2DM. Therefore, most patients with T2DM will require insulin treatment due to eventual loss of insulin secretion. Despite the evidence of early insulin treatment lowering macrovascular (coronary artery disease, peripheral arterial disease and stroke) and microvascular (diabetic nephropathy, neuropathy and retinopathy) complications of T2DM, controversy exists among physicians on how to initiate and intensify insulin therapy. The slow acting nature of regular human insulin makes its use ineffective in counteracting postprandial hyperglycemia. Instead, recombinant insulin analogs have been generated with a variable degree of specificity and action. Due to the metabolic variability among individuals, optimum blood glucose management is a formidable task to accomplish despite the presence of novel insulin analogs. In this article, we present a recent update on insulin analog structure and function with an overview of the evidence on the various insulin regimens clinically used to treat diabetes. PMID:23584214

Sanlioglu, Ahter D; Altunbas, Hasan Ali; Balci, Mustafa Kemal; Griffith, Thomas S; Sanlioglu, Salih

2013-01-01

314

New intravenous contrast media for choleography, urography and computer tomography  

International Nuclear Information System (INIS)

Based on the authors own experimental experiences and founded on literature the advantages and application possibilities of new contrast media in intravenous choleography, in urography and computer tomography are described and discussed. In intravenous choleography new contrast media have prooved an improvement of diagnostic yield and compatibility in connection with the infusion technique. New contrast media for urography and computer tomography are either ionic or strong hypertonic (Rayvist) ionic and less strong hypertonic (Hexabrix) or nonionic and less strong hypertonic (Amipaque, Iopomidol, Iotexol, Iopromid). The improvement of the strong hypertonic contrast media was brought a reduction in the frequency of general reactions as nausea and allergy-like reactions, however no improved cardiac cycle compatibility. The contrast media with reduced asmotic pressure were developped for myelography (Amipaque) or angiography for the first line. For the ionic oxaglat there could no sufficeint advantages be detected in adult intravenous applications. The nonionic contrast media can offer also in intravenous applications relevant advantages. Advantages of this kind cannot sufficiently be documented by clinical tests at the time being. It will be the problem of next years clinical research to determine for which patients and examinations the non-ionic contrast media offer what kind of advantages. For infant urography non-ionic contrast media are clearly recommended. (orig.)

315

New intravenous contrast media for choleography, urography and computer tomography  

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Based on the authors own experimental experiences and founded on literature the advantages and application possibilities of new contrast media in intravenous choleography, in urography and computer tomography are described and discussed. In intravenous choleography new contrast media have prooved an improvement of diagnostic yield and compatibility in connection with the infusion technique. New contrast media for urography and computer tomography are either ionic or strong hypertonic (Rayvist) ionic and less strong hypertonic (Hexabrix) or nonionic and less strong hypertonic (Amipaque, Iopomidol, Iotexol, Iopromid). The improvement of the strong hypertonic contrast media was brought a reduction in the frequency of general reactions as nausea and allergy-like reactions, however no improved cardiac cycle compatibility. The contrast media with reduced asmotic pressure were developped for myelography (Amipaque) or angiography for the first line. For the ionic oxaglat there could no sufficeint advantages be detected in adult intravenous applications. The nonionic contrast media can offer also in intravenous applications relevant advantages. Advantages of this kind cannot sufficiently be documented by clinical tests at the time being. It will be the problem of next years clinical research to determine for which patients and examinations the non-ionic contrast media offer what kind of advantages. For infant urography non-ionic contrast media are clearly recommended.

Speck, U.

1982-02-01

316

Evidence for effects of insulin on sensory processing in humans.  

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Systemic insulin passes the blood-brain barrier and insulin receptors have been detected in various brain regions. Yet, the biological significance of insulin acting on the brain remains rather unclear. Reports of different awareness of hypoglycemic symptoms during hypoglycemia induced by human insulin (HI) and porcine insulin (PI) suggest a modulatory influence of insulin on sensory processing. In a double-blind, within-subject, crossover comparison, we recorded visual-evoked potentials (VEP) in 30 healthy men during euglycemia and after 20 or 50 min of constant hypoglycemia of 2.66 mM (47.9 mg/dl) induced by HI and PI. Blood glucose and serum insulin levels were identical in both sessions. Hypoglycemia reduced amplitudes of the VEP components P1 and N2 and increased latencies of N1, P1, and N2. However, hypoglycemia-induced changes in VEP amplitudes and latencies were significantly stronger during PI and HI infusion: P1-N2 difference amplitude decreased from (mean +/- SE) 11.9 +/- 0.9 to 10.7 +/- 0.8 muV during HI and from 12.4 +/- 0.9 to 8.7 +/- 0.7 muV during PI infusion (P < 0.002). P1 latency increased from 112.0 +/- 3.2 to 118.8 +/- 3.2 ms during HI and from 114.0 +/- 3.3 to 126.3 +/- 4.6 ms during PI infusion (P < 0.05). Differences between the effects of the insulins were consistently apparent after 20 min of hypoglycemia, which indicates a short-term action of the hormone. The results add to those of a foregoing study demonstrating differential effects of HI- and PI-induced hypoglycemia on auditory evoked potentials.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8314007

Kern, W; Schlosser, C; Kerner, W; Pietrowsky, R; Born, J; Fehm, H L

1994-03-01

317

Cardiovascular effects in man of intravenous prizidilol hydrochloride (SK&F 92657); a new antihypertensive agent.  

Science.gov (United States)

1 Cardiovascular responses to intravenous prizidilol hydrochloride (SK&F 92657) 0.86 mg/kg were studied in eight supine resting healthy volunteers. Five subjects were slow and the remaining three were fast acetylators of sulphamethazine. Compared with pre-infusion values, mean resting systolic and diastolic blood pressures were significantly reduced, while mean resting pulse rate was significantly increased at 30 min after the start of the twenty minute infusion. 2 During the 6 h study period the lowest mean +/- s.e. mean systolic blood pressure (108.8 +/- 1.7) was recorded 30 min after the start of the infusion. This represented a mean reduction of 5.2 mmHg. Reductions in mean diastolic blood pressure were greater and of longer duration, the lowest mean value (44.8 +/- 2.0 mmHg) being recorded 3.5 h after the start of the infusion and representing a reduction of 18.5 mmHg from the pre-dosing value. At 6 h after the start of the infusion mean diastolic blood pressure was still significantly reduced (by 15.3 mmHg). 3 The maximum mean +/- s.e. mean resting pulse rate (79.3 +/- 4.4 beats/min) occurred 3 h after the start of the infusion, an increase of 23.0 beats/min over the pre-infusion value. At the end of the study the pulse rate was still significantly raised (by 17.7 beats/min). 4 The left ventricular ejection fraction, evaluated in five subjects, 45 min after the start of the infusion, was not altered by prizidilol hydrochloride, but the left ventricular area decreased significantly. 5 Intravenous prizidilol hydrochloride decreases resting blood pressure and left ventricular area, increases pulse rate and has virtually no effect on left ventricular ejection fraction. PMID:7295490

Edmonstone, W M; Manghani, K K; Bell, A J; McLeod, M; Milton-Thompson, G J; Burland, W L

1981-10-01

318

Insulin Sensitivity and Insulin Clearance are Heritable and Have Strong Genetic Correlation in Mexican Americans  

Science.gov (United States)

Objective We describe the GUARDIAN (Genetics UndeRlying DIAbetes in HispaNics) consortium, along with heritability estimates and genetic and environmental correlations of insulin sensitivity and metabolic clearance rate of insulin (MCRI). Design and Methods GUARDIAN is comprised of seven cohorts, consisting of 4336 Mexican-American individuals in 1346 pedigrees. Insulin sensitivity (SI), MCRI, and acute insulin response (AIRg) were measured by frequently sampled intravenous glucose tolerance test in four cohorts. Insulin sensitivity (M, M/I) and MCRI were measured by hyperinsulinemic-euglycemic clamp in three cohorts. Heritability and genetic and environmental correlations were estimated within the family cohorts (totaling 3925 individuals) using variance components. Results Across studies, age and gender-adjusted heritability of insulin sensitivity (SI, M, M/I) ranged from 0.23–0.48 and of MCRI from 0.35–0.73. The ranges for the genetic correlations were 0.91 to 0.93 between SI and MCRI; and ?0.57 to ?0.59 for AIRg and MCRI (all P<0.0001). The ranges for the environmental correlations were 0.54 to 0.74 for SI and MCRI (all P<0.0001); and ?0.16 to ?0.36 for AIRg and MCRI (P <0.0001?0.06). Conclusions These data support a strong familial basis for insulin sensitivity and MCRI in Mexican Americans. The strong genetic correlations between MCRI and SI suggest common genetic determinants. PMID:24124113

Goodarzi, Mark O.; Langefeld, Carl D.; Xiang, Anny H.; Chen, Yii-Der I.; Guo, Xiuqing; Hanley, Anthony J. G.; Raffel, Leslie J.; Kandeel, Fouad; Buchanan, Thomas A.; Norris, Jill M.; Fingerlin, Tasha E.; Lorenzo, Carlos; Rewers, Marian J.; Haffner, Steven M.; Bowden, Donald W.; Rich, Stephen S.; Bergman, Richard N.; Rotter, Jerome I.; Watanabe, Richard M.; Wagenknecht, Lynne E.

2013-01-01

319

Effect of hormone replacement therapy on insulin secretion and insulin sensitivity in postmenopausal diabetic women.  

Science.gov (United States)

The aim of the present study was to evaluate the effect of three different combinations of hormone replacement therapy (HRT) on insulin secretion, peripheral insulin sensitivity, serum lipid levels and parameters of oxidative stress. Seven type II diabetic women of mean age 55.4 +/- 4.7 years, who had been menopausal for an average of 5 years, were enrolled in the study. Phases of insulin secretion--first (FPIS) and second (SPIS)--and the area under the curve (AUC) for insulin secretion were studied during an intravenous glucose tolerance test (IVGTT). Insulin sensitivity was determined using the manual euglycemic-hyperinsulinemic clamp technique. Three different HRT combinations were applied consecutively for 3-month periods: estradiol valerate plus cyproterone acetate (Climen); transdermal 17 beta-estradiol (System TTS 50) plus dydrogesterone (Duphaston) 10 mg daily for 10 days a month; oral 17 beta-estradiol plus dydrogesterone (Femoston) for 14 days a month. A group of nine women with normal glucose tolerance (according to World Health Organization criteria during a 75-g oral glucose tolerance test (OGTT)), of mean age 50.1 +/- 8.2 years and mean body mass index 24.60 +/- 2.01 kg/m2, were also studied, and served as a control group. Insulin secretion improved significantly after Climen: FPIS increased by 16% and SPIS by 44%. Insulin sensitivity increased by 50% after Systen TTS 50 + Duphaston; fasting hyperinsulinemia was normalized and total antioxidant capacity of the serum (TAOCS) was significantly raised (p < 0.01). Femoston led to an increase in insulin sensitivity (by 23%) and in TAOCS (p < 0.05), while fasting hyperinsulinemia remained unchanged. HRT should be prescribed in type II diabetic postmenopausal women because of its favorable effect on existing pathophysiological defects. Cyproterone acetate should be preferred in cases with a predominant beta-cell insulin secretion defect, while dydrogesterone in combination with a transdermal estrogen should be recommended in cases with leading insulin resistance. PMID:11915585

Borissova, A M; Tankova, T; Kamenova, P; Dakovska, L; Kovacheva, R; Kirilov, G; Genov, N; Milcheva, B; Koev, D

2002-02-01

320

Systemic and regional hemodynamic effects of enalaprilat infusion in experimental normotensive sepsis  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english Angiotensin-converting enzyme inhibitors have been shown to improve splanchnic perfusion in distinct shock states. We hypothesized that enalaprilat potentiates the benefits of early fluid resuscitation in severe experimental sepsis, particularly in the splanchnic region. Anesthetized and mechanicall [...] y ventilated mongrel dogs received an intravenous infusion of live Escherichia coli over a period of 30 min. Thereafter, two interventions were performed: fluid infusion (normal saline, 32 mL/kg over 30 min) and enalaprilat infusion (0.02 mg kg-1 min-1 for 60 min) in randomized groups. The following groups were studied: controls (fluid infusion, N = 4), E1 (enalaprilat infusion followed by fluid infusion, N = 5) and E2 (fluid infusion followed by enalaprilat infusion, N = 5). All animals were observed for a 120 min after bacterial infusion. Mean arterial pressure, cardiac output (CO), portal vein blood flow (PVBF), systemic and regional oxygen-derived variables, and lactate levels were measured. Rapid and progressive reductions in CO and PVBF were induced by the infusion of live bacteria, while minor changes were observed in mean arterial pressure. Systemic and regional territories showed a significant increase in oxygen extraction and lactate levels. Widening venous-arterial and portal-arterial pCO2 gradients were also detected. Fluid replacement promoted transient benefits in CO and PVBF. Enalaprilat after fluid resuscitation did not affect systemic or regional hemodynamic variables. We conclude that in this model of normotensive sepsis inhibition of angiotensin-converting enzyme did not interfere with the course of systemic or regional hemodynamic and oxygen-derived variables.

L., Rahal; A.G., Garrido; R.J., Cruz Jr.; M., Rocha e Silva; L.F., Poli-de-Figueiredo.

1205-12-01

 
 
 
 
321

FIRST-PHASE INSULIN SECRETION, INSULIN SENSITIVITY, GHRELIN, GLP-1, AND PYY LEVEL CHANGES 72 HRS AFTER SLEEVE GASTRECTOMY IN OBESE DIABETIC PATIENTS: THE GASTRIC HYPOTHESIS  

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Full Text Available In diabetic patients who had the disease less than 10.5 years, the first phase of insulin secretion promptly improved after SG. The early insulin area under the curve (AUC significantly increased at the postoperative IVGTT, indicating an increased glucose-induced insulin secretion. The second phase of insulin secretion (late AUC significantly decreased after SG in all groups, indicating an improved insulin peripheral sensitivity. In all groups, pre- and postoperatively, intravenous glucose stimulation determined a decrease in ghrelin values and an increase in GLP-1 and PYY values. However, in the group of patients with disease duration >10.5 years, the differences were not significant except for the late insulin AUC. Postoperative basal and intravenous glucose-stimulated ghrelin levels were lower than preoperative levels in all groups of patients. Basal and intravenous stimulated GLP-1 and PYY postoperative values were higher than preoperative levels in all groups. Restoration of the first phase of insulin secretion and improved insulin sensitivity in diabetic obese patients immediately after SG, before any food passage through the gastrointestinal tract and before any weight loss, seem to be related to ghrelin, GLP-1, and PYY hormonal changes of possible gastric origin and was neither meal- nor weight-change-related. Duration of the disease up to 10.5 years seems to be a major cut off in the pathophysiological changes induced by SG. A "gastric" hypothesis may be put forward to explain the anti-diabetes effect of SG.

Mukesh Kumar Meena*, Bhandari M, Varma M, Shrivastav RK and Jain VK

2013-10-01

322

Severe and prolonged hypophosphatemia after intravenous iron administration in a malnourished patient.  

Science.gov (United States)

Malnutrition may result in a phosphate-deficient state owing to a chronically insufficient phosphate intake. Concomitant iron deficiency is common and often supplemented by the intravenous route. It is not widely recognized that some parenteral iron formulations can induce hypophosphatemia. Herein we report a case of a severe and symptomatic hypophosphatemia (0.18 mM, normal range 0.8-1.4 mM) associated with an inappropriately reduced tubular reabsorption of phosphate (33%, norm >95%) in a malnourished patient with anorexia/bulimia who received 2 × 500 mg iron carboxymaltose (FCM) intravenously. Despite intravenous and oral phosphate supplements, it required 2 months to achieve a normal serum phosphate level. Our case demonstrates that in a chronically malnourished and phosphate-deficient state intravenous FCM could potentially be dangerous. If this form of iron application cannot be avoided, phosphate supplementation before and after iron infusion as well as close monitoring of phosphate levels are needed. PMID:24569537

Fierz, Y C; Kenmeni, R; Gonthier, A; Lier, F; Pralong, F; Coti Bertrand, P

2014-04-01

323

Cyclic intravenous pamidronate in treatment of osteoporosis  

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Full Text Available Objective To assess the efficacy and tolerability of cyclic intravenous pamidronate therapy in women with severe osteoporosis. Material and methods Bone mineral density (BMD measurement was performed by dual-energy X-ray absorptiometry using LUNAR DPX-L device. Slow intravenous infusion regimens of pamidronate (30 mg every three months were used in treatment of 240 women, in addition to supplemental Ca and vitamin D. Bone mineral density was measured from lumbar spine 1 year later (120 mg of pamidronate in 195 women and 2 years later (240 mg of pamidronate in 29 women. The placebo group included 63 women treated only with calcium and vitamin D. Results The average age of 240 women with severe osteoporosis was 61.2±9.5. All were postmenopausal, except for two of them. Their mean age at the onset of menopause was 46.2±5.6. Mean duration of menopause was 15.7±8.1. After 1 year of therapy, bone mineral density increased from 0.781 g/cm2 to 0.837 g/cm2 (p<0.001, the mean increase bone mass was 7.2% (p<0.0001. After 2 years, bone mineral density increased to 0,844 g/cm2, the improvement was 8.1% from baseline (p<0.001. Bone mineral density in the placebo group, after one year, significantly increased (p=0.046 from 0.966 g/cm2 to 1.004 g/cm2, the improvement was 3.9%. However, after two years, bone mineral density decreased to 0.973 g/cm2, and compared with baseline this change was 0.7% and not significant (p> 0.05. Conclusion Pamidronate prevented further decrease of BMD in our patients with severe osteoporosis and also increased BMD in these patients. This safe and efficient drug is well tolerated.

Vujasinovi?-Stupar Nada

2004-01-01

324

Ultrasonography versus intravenous urography  

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The present study was performed to compare the clinical value of urography and ultrasonography in a non-selected group of patients referred for urography to a university hospital. The conslusions and clinical implications of the study are as follows: Intravenous urography remains the cornerstone imaging examination in the evaluation of ureteral calculi. Ultrasonography is a valuable adjunct in cases of non- visualization of the kidneys, in distal obstruction and known contrast media allergy. When women with recurrent urinary tract infection are referred for imaging of the urinary tract, ultrasonography should be used. Ultrasonography should replace urography for screening of non-acute hydronephrosis like in female genital cancer and benign prostate hyperplasia. There is good correlation between urography and ultrasonography in assessing the degree of hydronephrosis. However, more researh on the relationship between hydronephrosis and obstruction is necessary. Ultrasonography should be used as the only imaging method of the upper urinary tract in patients with microscopic hematuria. In patients less than 50 years with macroscopic hematuria, ultrasonography should be used as the only imaging of the upper urinary tract, and an examination of the urinary bladder should be included. In patients over 50 years, urography supplied with ultrasonography should be used, but more research is necessary on the subject of imaging method and

325

Hepatic glycogen in humans. II. Gluconeogenetic formation after oral and intravenous glucose  

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The amount of glycogen that is formed by gluconeogenetic pathways during glucose loading was quantitated in human subjects. Oral glucose loading was compared with its intravenous administration. Overnight-fasted subjects received a constant infusion or [3-3H]glucose and a marker for gluconeogenesis, [U-14C]lactate or sodium [14C]bicarbonate [14C]bicarbonate. An unlabeled glucose load was then administered. Postabsorptively, or after glucose infusion was terminated, a third tracer ([6-3H]glucose) infusion was initiated along with a three-step glucagon infusion. Without correcting for background stimulation of [14C]glucose production or for dilution of 14C with citric acid cycle carbon in the oxaloacetate pool, the amount of glycogen mobilized by the glucagon infusion that was produced by gluconeogenesis during oral glucose loading was 2.9 +/- 0.7 g calculated from [U-14C]-lactate incorporation and 7.4 +/- 1.3 g calculated using [14C]bicarbonate as a gluconeogenetic marker. During intravenous glucose administration the latter measurement also yielded 7.2 +/- 1.1 g. When the two corrections above are applied, the respective quantities became 5.3 +/- 1.7 g for [U-14C]lactate as tracer and 14.7 +/- 4.3 and 13.9 +/- 3.6 g for oral and intravenous glucose with [14C]bicarbonate as tracer (P less than 0.05, vs. [14C]-lactate as tracer). When [2-14C]acetate was infused, the same amount of label was incorporated into mobilized glycogen regardless of which route of glucose administration was used. Comparison with previous data also suggests that 14CO2 is a potentially useful marker for the gluconeogenetic process in vivo

326

Phase I safety trial of intravenous ascorbic acid in patients with severe sepsis  

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Background Parenterally administered ascorbic acid modulates sepsis-induced inflammation and coagulation in experimental animal models. The objective of this randomized, double-blind, placebo-controlled, phase I trial was to determine the safety of intravenously infused ascorbic acid in patients with severe sepsis. Methods Twenty-four patients with severe sepsis in the medical intensive care unit were randomized 1:1:1 to receive intravenous infusions every six hours for four days of ascorbic acid: Lo-AscA (50 mg/kg/24 h, n?=?8), or Hi-AscA (200 mg/kg/24 h, n?=?8), or Placebo (5% dextrose/water, n?=?8). The primary end points were ascorbic acid safety and tolerability, assessed as treatment-related adverse-event frequency and severity. Patients were monitored for worsened arterial hypotension, tachycardia, hypernatremia, and nausea or vomiting. In addition Sequential Organ Failure Assessment (SOFA) scores and plasma levels of ascorbic acid, C-reactive protein, procalcitonin, and thrombomodulin were monitored. Results Mean plasma ascorbic acid levels at entry for the entire cohort were 17.9?±?2.4 ?M (normal range 50-70 ?M). Ascorbic acid infusion rapidly and significantly increased plasma ascorbic acid levels. No adverse safety events were observed in ascorbic acid-infused patients. Patients receiving ascorbic acid exhibited prompt reductions in SOFA scores while placebo patients exhibited no such reduction. Ascorbic acid significantly reduced the proinflammatory biomarkers C-reactive protein and procalcitonin. Unlike placebo patients, thrombomodulin in ascorbic acid infused patients exhibited no significant rise, suggesting attenuation of vascular endothelial injury. Conclusions Intravenous ascorbic acid infusion was safe and well tolerated in this study and may positively impact the extent of multiple organ failure and biomarkers of inflammation and endothelial injury. Trial registration ClinicalTrials.gov identifier NCT01434121. PMID:24484547

2014-01-01

327

Hypersensitivity reactions to intravenous iron: guidance for risk minimization and management  

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Intravenous iron is widely used for the treatment of iron deficiency anemia when oral iron is inappropriate, ineffective or poorly tolerated. Acute hypersensitivity reactions during iron infusions are very rare but can be life-threatening. This paper reviews their frequency, pathogenesis and risk factors, and provides recommendations about their management and prevention. Complement activation-related pseudo-allergy triggered by iron nanoparticles is probably a more frequent pathogenetic mechanism in acute reactions to current formulations of intravenous iron than is an immunological IgE-mediated response. Major risk factors for hypersensitivity reactions include a previous reaction to an iron infusion, a fast iron infusion rate, multiple drug allergies, severe atopy, and possibly systemic inflammatory diseases. Early pregnancy is a contraindication to iron infusions, while old age and serious co-morbidity may worsen the impact of acute reactions if they occur. Management of iron infusions requires meticulous observation, and, in the event of an adverse reaction, prompt recognition and severity-related interventions by well-trained medical and nursing staff.

Rampton, David; Folkersen, Joergen; Fishbane, Steven; Hedenus, Michael; Howaldt, Stefanie; Locatelli, Francesco; Patni, Shalini; Szebeni, Janos; Weiss, Guenter

2014-01-01

328

The intravenous intralipid tolerance test.  

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The half-life of an intravenously injected bolus of intralipid 20% was measured in normal rats in order to asess its relationship to reticuloendothelial system (RES) activity. Groups of animals were studied following various treatments, and the results compared to measurement of carbon clearance in similar groups. The RES effects of silica and C parvum were confirmed by the carbon clearance test, but no effect was seen on the half-life of intralipid. Intralipid clearance was shortened by fasting and the administration of intravenous heparin, neither of which affected carbon clearance. It is concluded that the intravenous intralipid test has no place in the asessment of RES function. PMID:6593393

Fraser, I; Pearson, H; Bowry, V; Bell, P R

1984-11-01

329

Theoretical, clinical and pharmacokinetic aspects of cancer chemotherapy administered by continuous infusion  

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This chapter reviews some of the theoretical and empirical aspects of the administration of anti-cancer drugs by continuous intravenous infusion in conjunction with radiation therapy. The variables contributing to schedule dependence of anti-cancer drugs are discussed. A table shows the improved therapeutic index of Bleomycin by continuous infusion in mice. The use of Cytarabine, a pyrimidine anti-metabolite which kills cells during S-phase or DNA synthesis, is examined. Fluorouracil and Doxorubicin are examined and several other drugs including vincristine, vinblastine, etoposide, and cisplatin are discussed

330

Sensibilidad a la insulina en ovejas prepúberes con alimentación normal y con restricción alimenticia Insulin sensitivity in prepubertal growing ewes with normal and restricted alimentation  

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Full Text Available Se ha demostrado, en borregas en crecimiento, que el ayuno está asociado a resistencia insulínica como un fenómeno adaptativo a la baja ingesta calórica. La restricción alimenticia es otra situación natural o experimental que puede enfrentar la hembra en crecimiento, en la cual la disponibilidad de energía está por debajo de los requerimientos indispensables para el crecimiento. La sensibilidad a la insulina podría cambiar también como una adaptación fisiológica a la escasez de alimento. El objetivo del presente estudio fue reconocer si la sensibilidad a la insulina disminuye durante la restricción alimenticia de borregas en crecimiento. La sensibilidad a la insulina se evaluó con el test de tolerancia a la glucosa endovenosa (TTGEV. Cinco borregas con crecimiento normal y cinco borregas con restricción alimenticia por seis semanas, a partir de las 20 semanas de edad, se infundieron con una solución estéril de glucosa (300 mg/kg peso corporal, solución al 50% en dos minutos. Se colectaron muestras de sangre desde la yugular mediante un catéter venoso 15 y 10 minutos antes de la infusión de glucosa, y a los 0, 3, 5, 7, 10, 13, 15, 17, 20, 23, 25, 27, 30 minutos después del inicio de la infusión en cuyo plasma se midió glucosa e insulina. Las concentraciones de glucosa (g/l e insulina (µUI/ml se analizaron con la fórmula de Matsuda y DeFronzo para determinar el índice de sensibilidad a la insulina (ISI-Composite. Se calculó también el área bajo la curva de insulina basal, estimulada e incremental y la constante de utilización de la glucosa. El ISI-C fue menor en las borregas con restricción alimenticia (636,43± 125,66 en comparación con las borregas controles (1528,18 ± 297,61 PIt has been shown that fasting in growing ewes is associated with insulin resistance as an adaptative mechanism to the low energy supply. Food restriction is another experimental or natural situation that may occur for growing ewes where energy supply is under the requirement for growth. Insulin sensitivity may also change as a physiological adaptation to the shortage of food. The aim of the present study was to assess if insulin sensitivity decreases during food restriction in growing ewes. Insulin sensitivity was assessed by the intravenous glucose tolerance test (IVGTT. A glucose solution (300mg/kg body weight, 50% solution was infused over two minutes into five normal growing 26-week old ewes and five 26 week-old ewes that had been restrictively fed from the age of 20 to 26 weeks. Blood samples were collected from the jugular vein of each ewe by an indwelling jugular vein catheter 15 and 10 min before and at 0, 3, 5, 7, 10, 13, 15, 17, 20, 23, 25, 27 and 30 min after the initiation of the glucose infusion, and plasma glucose and insulin were measured by RIA. To determine the insulin sensitivity index (ISI, glucose and insulin concentrations were analyzed using the Matsuda and De Fronzo's formula (ISI-Composite. Basal, stimulated and incremental area under the curve of insulin and the glucose utilization constants were also calculated. ISI-C was lower in food-restricted female sheep (636.43 ± 125.66 compared to normal growing females (1528.18 ± 297.61, (P < 0.05. Concordant with this, incremental area under the curve of insulin was lower (290.54 ± 79.45 ng/ml/30 min in control than in food-restricted females (642.16 ± 140.04 ng/mL/30 min, P < 0.05. The glucose utilization constant did not differ between groups. Results suggest that food restriction induces insulin resistance as an adaptative process to the shortage of food in growing female sheep

S E Recabarren

2005-01-01

331

Diabetes and Insulin  

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... 2 diabetes, the body does not produce enough insulin and it becomes resistant to insulin’s effects. It occurs in adults and elderly patients, ... 2 diabetes later in life, however. and Diabetes Insulin What Is DIabetes? Diabetes is a disease in ...

332

Insulin action under arrestin.  

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Insulin signaling is key to the etiology of metabolic syndrome. Recent work (Luan et al., 2009) uncovers a role for beta-arrestin, previously known to control GPCR desensitization, in insulin signaling. In mouse models, beta-arrestin-2 controls whole-body insulin action by regulating assembly of a complex containing insulin receptor, c-Src, and Akt. PMID:19254565

Stöckli, Jacqueline; James, David E

2009-03-01

333

Sequential infusion of donor-derived dendritic cells with donor lymphocyte infusion for relapsed hematologic cancers after allogeneic hematopoietic stem cell transplantation.  

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Donor lymphocyte infusion (DLI) is often given to induce a graft-versus-leukemia (GVL) effect after allogeneic hematopoietic stem cell transplantation (HSCT). However, efficacy of DLI is limited in most hematologic cancers. As antigen presenting cells, dendritic cells (DC) bolster immune responses. We conducted a Phase I trial testing the coinfusion of DC followed by DLI. DC were generated by culturing peripheral blood mononuclear cells from HLA matched-related donors in GM-CSF and IL-4 for 7 days, followed by TNF-? for 3 days. DC were administered intravenously on 3 dose levels (5 × 10(6) ; 1 × 10(7) ; 5 × 10(7) cells). DLI (3 × 10(7) CD3+ cells/kg) was administered intravenously 1 day after the DC. Sixteen patients with hematologic cancers relapsed after HSCT were treated. A maximum tolerated dose for DC was not reached. Two of 16 patients met criteria for DLT within 10 weeks of the infusion: 1 idiopathic respiratory failure, 1 ventricular cardiac arrest. None developed grade III/IV GVHD. One patient developed grade II acute intestinal graft-vs.-host disease (GVHD) and 1 chronic GVHD within 6 months of the infusion. Both resolved with corticosteroids. Four of 14 patients evaluable for disease response achieved durable remissions and are alive and cancer free 6.7, 8.4, 8.8, and 10.1 years from infusion. Sequential infusion of donor-derived DC with DLI is feasible in patients with relapsed hematologic cancers after allogeneic HSCT. Future studies may consider donor DC preloaded with tumor antigens to investigate whether DC infusion could augment the GVL effect. Am. J. Hematol. 89:1092-1096, 2014. © 2014 Wiley Periodicals, Inc. PMID:25132538

Ho, Vincent T; Kim, Haesook T; Kao, Grace; Cutler, Corey; Levine, James; Rosenblatt, Jacalyn; Joyce, Robin; Antin, Joseph H; Soiffer, Robert J; Ritz, Jerome; Avigan, David; Alyea, Edwin P

2014-12-01

334

Comparison of the Effect of Intravenous and Epidural Administration of Fentanyl on Pain Severity and Hemodynamic Status in Patients with Abdominal and Thoracic Trauma  

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Full Text Available Background: The pain of the chest and abdominal injuries in patients who undergoing mechanical ventilation is controlled by regional or systemic administration of drugs. We designed this study for comparison of effect of intravenous and epidural injection of fentanyl on pain reduction and hemodynamic status in patients with abdominal and thoracic injuries. Materials and Methods: In this prospective clinical trial study, we randomly allocate 60 patients aged 16 to 80 years who were undergoing mechanical ventilation due to thoracic or abdominal injuries, to two groups. In B group during first 24 hour of admission pain management was done by epidural infusion of fentanyl and in the next 24 hours, this method was changed to intravenous infusion of fentanyl. In A group, initially method was intravenous and after 24 hours, we changed it to epidural method. We assessed pain score and hemodynamic status at the specific times.Results: In both groups after first 2 hours, pain sore was significantly lower in intravenous method but after 6 hours, pain score was significantly lower in epidural method. Hemodynamic status in epidural method was significantly more stable than IV method.Conclusion: This study showed that for patients who were undergoing mechanical ventilation due to chest or abdominal injuries, intravenous infusion of fentanyl provides more pain relief during first two hours but after six hours epidural method is better than intravenous infusion.

Mehdi Ahmadinejad

2013-02-01

335

Effect of intravenous nitroglycerin therapy on erythrocyte antioxidant enzymes.  

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Intravenous nitroglycerin (GTN) has been used as an anti-ischemic agent for the therapy of unstable and post-infarction angina. Nitric oxide (NO) and S-nitrosothiols constitute the biologically active species formed via nitroglycerin bioactivation. Increased levels of reactive oxygen species can diminish the therapeutic action of organic nitrates by scavenging donated NO and oxidizing tissue thiols important in nitrate biotransformation. Studies reported here show that the red cell activity of antioxidant enzymes, catalase and glutathione peroxidase, are significantly decreased after intravenous nitroglycerin treatment. Catalase activity (739.6 +/- 92.3 k/gHb) decreased to 440.1 +/- 111.9 and 459.8 +/- 130.7 k/gHb after 1 and 24 hr GTN infusion, respectively. Similarly, glutathione peroxidase activity (5.8 +/- 1.8 U/gHb) decreased to 3.2 +/- 1.7 and 3.8 +/- 1.1 U/g Hb after 1 and 24 hr GTN infusion, respectively. The reported decrease in antioxidant enzyme activities can lead to an oxidant milieu and contribute to the generation of nitrate tolerance. PMID:16119201

Alicigüzel, Yakup; Akta?, Serpil; Bozan, Hayri; Aslan, Mutay

2005-06-01

336

Insulin resistance associated with maternally inherited diabetes and deafness.  

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Maternally inherited diabetes and deafness (MIDD) is a form of diabetes associated with mutation of mitochondrial DNA (mtDNA) that occurs in 1% to 2% of individuals with diabetes. Understanding the clinical course and abnormalities in insulin secretion and action in affected individuals should allow better understanding of how this genetic defect alter glucose metabolism. We report the clinical course of three individuals with mtDNA mutations and deafness. Subjects no. 1 and 2 had diabetes not yet requiring insulin therapy, and subject no. 3, the son of subject no. 2, had normal glucose tolerance. Defective oxidative phosphorylation (OXPHOS) based on OXPHOS enzymology of skeletal muscle biopsy of subjects no. 1 and 2 showed activity of less than 5% of the tolerance level in complex III for subject no. 1 and in complexes I, I + III, and IV for subject no. 2. Assessing insulin secretion using insulin response to intravenous glucose and insulin sensitivity based on minimal model analysis of an insulin-modified frequently sampled intravenous glucose tolerance test (FSIGT), first-phase insulin secretion was abnormal in subjects no. 1 and 2 and normal in subject no. 3 (AUC, 57, 93, and 1,235 pmol/L, respectively). In contrast, all three subjects had low insulin sensitivity indices (0.04, 0.14, and 0.27 x 10-4 x min/pmol/L, respectively). Subject no. 2, who underwent three FSIGT studies over a 16-month interval, showed transient improvement in insulin release in response to modification of diet and exercise (first-phase insulin AUC, 57 pmol/min v 287 pmol/min 10 months later; fasting insulin, 97 pmol/L v 237 pmol/L 10 months later), but by 16 months, first-phase insulin release and fasting insulin had decreased (AUC, 64 and 136 pmol/L, respectively) despite higher fasting glucose. We conclude that in our subjects with MIDD, insulin resistance is present and appears to precede defects in insulin release. PMID:8609843

Gebhart, S S; Shoffner, J M; Koontz, D; Kaufman, A; Wallace, D

1996-04-01

337

Body temperature, behavior, and plasma cortisol changes induced by chronic infusion of Staphylococcus aureus in goats.  

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Most experimentally induced fevers are acute, usually lasting approximately 6-12 h, and thus do not mimic chronic natural fevers, which can extend over several days or more. To produce a model of chronic natural fever, we infused eight goats (Capra hircus) intravenously with 2 ml of 2 x 10(11) cell walls of Staphylococcus aureus (S. aureus) for 6 days using osmotic infusion pumps (10 microl/h) while measuring changes in body temperature, behavior, and plasma cortisol concentration. Seven control animals were infused with sterile saline. Abdominal temperature-sensitive data loggers and osmotic infusion pumps were implanted under halothane anesthesia. To compare our new model with existing models of experimental fever, we also administered 2-ml bolus intravenous injections of 2 x 10(11) S. aureus cell walls, 0.1 microg/kg lipopolysaccharide (Escherichia coli, serotype 0111:B4), and sterile saline in random order to six other goats. Bolus injection of lipopolysaccharide and S. aureus induced typical acute phase responses, characterized by fevers lasting approximately 6 h, sickness behavior, and increased plasma cortisol concentration. Infusion of S. aureus evoked prolonged fevers, which lasted for approximately 3 days, starting on day 4 of infusion (ANOVA, P cortisol concentration to rise (ANOVA, P > 0.05) or the expression of sickness behavior. In conclusion, infusion of S. aureus produced a fever response resembling that of sustained natural fevers but did not elicit the cortisol and behavioral responses that often are described clinically and during short-term experimental fevers. PMID:15217786

Mphahlele, Noko R; Fuller, Andrea; Roth, Joachim; Kamerman, Peter R

2004-10-01

338

Regulation of the insulin-like growth factor system by insulin in burn patients.  

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The aim of the present investigation was to determine whether there is a net uptake of insulin-like growth factor I (IGF-I) or IGF-binding proteins (IGFBPs) by the leg after burn injury and to elucidate the regulatory role of insulin exerted on this system under in vivo conditions in burn patients. Studies were performed on nine patients after burn injury (approximately 60% body surface area). Each patient was studied twice during a continuous infusion of a carbohydrate-rich enteral diet. Blood was collected simultaneously from the femoral artery and vein for the measurement of various elements of the IGF system after 7 days of enteral diet alone (basal period) and after 7 days of the enteral diet plus the infusion of insulin (insulin period). Data from these patients were compared to values in age-matched fed healthy volunteers. During the basal period, burn patients demonstrated a significant reduction in the venous concentration of IGF-I and an increase in both IGFBP-1 and -2 compared to control values. Insulin produced a significant 15% increase in the IGF-I concentration in burn patients, but decreased the circulating levels of IGFBP-1 by 50%. The IGF-I and IGFBP-1 concentrations at the end of the insulin period were still significantly different from those in control subjects. Burn patients also exhibited a marked reduction in intact IGFBP-3 and the acid-labile subunit under basal conditions, and these alterations were not reversed by insulin. Under basal conditions, all burn patients had a positive arterio-venous (A-V) difference for IGF-I across the leg. The A-V difference was increased 50% in response to insulin. The net uptake of IGF-I by the leg was 2.4 micrograms/min under basal conditions, and as leg blood flow also tended to increase in response to insulin, IGF-I uptake was elevated more than 3-fold during the insulin period. No A-V difference across the leg was detected for IGFBP-1, -2, or -3 in burn patients. In conclusion, burn injury in humans produces dramatic and sustained alterations in various components of the IGF system that persist despite adequate nutritional support. Our data indicate the presence of a net uptake of IGF-I by the leg in burn patients that may serve to counteract the catabolic state. PMID:8675563

Lang, C H; Fan, J; Frost, R A; Gelato, M C; Sakurai, Y; Herndon, D N; Wolfe, R R

1996-07-01

339

Intravenous lipid emulsion in clinical toxicology  

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Full Text Available Abstract Intravenous lipid emulsion is an established, effective treatment for local anesthetic-induced cardiovascular collapse. The predominant theory for its mechanism of action is that by creating an expanded, intravascular lipid phase, equilibria are established that drive the offending drug from target tissues into the newly formed 'lipid sink'. Based on this hypothesis, lipid emulsion has been considered a candidate for generic reversal of toxicity caused by overdose of any lipophilic drug. Recent case reports of successful resuscitation suggest the efficacy of lipid emulsion infusion for treating non-local anesthetic overdoses across a wide spectrum of drugs: beta blockers, calcium channel blockers, parasiticides, herbicides and several varieties of psychotropic agents. Lipid emulsion therapy is gaining acceptance in emergency rooms and other critical care settings as a possible treatment for lipophilic drug toxicity. While protocols exist for administration of lipid emulsion in the setting of local anesthetic toxicity, no optimal regimen has been established for treatment of acute non-local anesthetic poisonings. Future studies will shape the evolving recommendations for lipid emulsion in the setting of non-local anesthetic drug overdose.

Oswald Sarah

2010-10-01

340

Effect of magnesium infusion on thoracic epidural analgesia  

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Full Text Available Introduction: Patients of lung volume reduction surgery (LVRS having an ASA status III or more are likely to be further downgraded by surgery to critical levels of pulmonary function. Aim: To compare the efficacy of thoracic epidural block with (0.125% bupivacaine, fentanyl combination and (0.125% bupivacaine, fentanyl combination with adjunctive intravenous magnesium infusion for the relief of postoperative pain in patients undergoing LVRS. Methods: Patients were operated under general anesthesia. Thirty minutes before the anticipated completion of skin closure in both groups, (Group A and Group B 7 ml of (0.125% bupivacaine calculated as 1.5 ml/thoracic segment space for achieving analgesia in dermatomes of T4, T5, T6, T7, and T8 segments, along with fentanyl 50 ?g (0.5 ml, was administered through the catheter, activating the epidural block, and the time was noted. Thereafter, in patients of Group A, magnesium sulfate injection 30 mg/kg i.v. bolus was followed by infusion of magnesium sulfate at 10 mg/kg/hr and continued up to 24 hours. Group B was treated as control. Results and Analysis: A significant increase in the mean and maximum duration of analgesia in Group A in comparison with Group B (P<0.05 was observed. Total epidural dose of fentanyl and bupivacaine required in Group A was significantly lower in comparison with Group B in 24 hours. Discussion: Requirement of total doses of local anesthetics along with opioids could be minimized by magnesium infusion; therefore, the further downgradation of patients of LVRS may be prevented. Conclusion: Intravenous magnesium can prolong opioid-induced analgesia while minimizing nausea, pruritus, and somnolence.

Gupta Sampa

2011-01-01

 
 
 
 
341

The effect of timing of intravenous muscle relaxant on the quality of double-contrast barium enema  

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AIM: To determine whether the timing of buscopan administration during double-contrast barium enema examination (DCBE) affects diagnostic quality. MATERIALS AND METHODS: In a prospective setting, 100 consecutive adult out-patients referred for DCBE received 20 mg buscopan (hyoscine-N-butylbromide) intravenously, either before infusion of barium suspension (Group A) or after barium infusion and gas insufflation (Group B). A subjective assessment of ease of contrast medium infusion was made at the time of examination and the films subsequently analysed by two radiologists unaware of the mode of relaxant administration, who noted the quality of mucosal coating and made subjective and objective measurements of segmental distension. RESULTS: There was no significant difference in screening times, infusion difficulty or colonic contrast medium coating between the two groups. Subjective assessment of distension of the caecum, ascending colon, transverse colon and rectum were not significantly different. Patients receiving intravenous relaxant after barium and gas infusion had less subjective descending (P = 0.05) and sigmoid (P = 0.04) colon distension, but there was no significant difference with respect to maximal bowel diameter in any of the segments measured. CONCLUSION: The timing of intravenous administration during DCBE is likely to have no significant effect on the diagnostic quality of the study. Elson, E.M. (2000)

342

Preparation and characterization of monomethoxypoly(ethylene glycol)-insulin conjugates.  

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Insulin was modified with monomethoxypoly(ethylene glycol) 5000 (MPEG5000) by reaction of insulin amino groups with activated MPEG5000, and mono-, di- and tri-PEGylated insulin were obtained. Circular dichroism demonstrated that the attachment of MPEG5000 to insulin did not alter the tertiary structure of insulin. PEGylation of insulin could inhibit the self-association tendency of insulin, which decreased with the increase of substitution degree. The physical stability and proteolytic stability of insulin increased after MPEG conjugation, and the stabilities of the conjugates depended on the PEGylation degree. In vivo biological activity of mono-PEGylated insulin following parenteral administration both in mice and rats was preserved while di- and tri-PEGylated insulin showed a great loss in biological activity. In addition, mono-PEGylated insulin administered subcutaneously in mice as well as intravenously in rats displayed extended action profiles. These results indicated that mono-substituted MPEG5000-insulin conjugate was a good candidate for insulin replacement therapy. PMID:19348342

Zhang, Min; Dou, Huaizhi; Yin, Lichen; Zhang, Yu; Zhu, Siyu; Yin, Chunhua

2009-03-01

343

Glucosamine induces insulin resistance in vivo by affecting GLUT 4 translocation in skeletal muscle. Implications for glucose toxicity.  

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Glucosamine (Glmn), a product of glucose metabolism via the hexosamine pathway, causes insulin resistance in isolated adipocytes by impairing insulin-induced GLUT 4 glucose transporter translocation to the plasma membrane. We hypothesized that Glmn causes insulin resistance in vivo by a similar mechanism in skeletal muscle. We performed euglycemic hyperinsulinemic clamps (12 mU/kg/min + 3H-3-glucose) in awake male Sprague-Dawley rats with and without Glmn infusion at rates ranging from 0.1 to...

Baron, A. D.; Zhu, J. S.; Zhu, J. H.; Weldon, H.; Maianu, L.; Garvey, W. T.

1995-01-01

344

Effect of metabolic clearance rate and hepatic extraction of insulin on hepatic and peripheral contributions to hypoglycemia.  

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Effects of alterations in metabolic clearance rates, hepatic extraction, and plasma concentrations of insulin on hepatic and peripheral contribution to hypoglycemia and glucose counterregulation were studied in conscious dogs. Since insulin and sulfated insulin had markedly different metabolic clearance rates (34 +/- 1 vs. 16 +/- 1 ml/kg per min, respectively) and fractional hepatic extraction (42 +/- 1% vs. 15 +/- 2%, respectively), biologically equivalent amounts infused intraportally produ...

Chap, Z.; Ishida, T.; Chou, J.; Hartley, C. J.; Lewis, R. M.; Entman, M.; Field, J. B.

1985-01-01