Drip Infusion Research Articles

Drip infusion cholangiography with CT in cats.

Ultrasonography can detect extrahepatic biliary obstructions. However, visualisation of part of the bile duct using ultrasonography can be technically difficult if there is overlying bowel gas. This study investigated the safety and value of drip infusion cholangiography with computed tomography (DIC-CT) in the visualisation of the bile duct in healthy cats and extrahepatic biliary obstruction in cats with cholelithiasis. DIC-CT was performed in three healthy cats and two cats with cholelithiasis. Meglumine iotroxate was administered by intravenous drip infusion over 30 mins. The attenuation value was measured perpendicular to the lumen by a region of interest covering about 50% of the area of the lumen. The bile ducts were visualised successfully with DIC-CT in all healthy cats without any significant adverse events. The attenuation value of the contrast medium was 271 ± 37 HU. In the two cats with cholelithiasis, the presence or absence of extrahepatic biliary obstruction was determined using DIC-CT without any significant adverse events. The attenuation value of cholelithiasis in the cat with an extrahepatic biliary obstruction was 933 ± 119 HU. In the cat with no extrahepatic biliary obstruction, the attenuation value of the contrast medium was 249 ± 53 HU and the attenuation value of cholelithiasis was 167 ± 28 HU. DIC-CT visualises bile ducts and detects obstructive biliary disease without significant adverse events. Therefore, it appears to be a safe procedure for visualisation of the bile duct in cats.

EFFICIENCY OF INHALATION AND PARENTAL THERAPY OF ACUTE BRONCHIAL OBSTRUCTION SYNDROME BY INFECTIOUS OR ALLERGIC GENESIS IN CHILDREN. PRINCIPLES AND TECHNIQUE OF INHALATIONS

Relevance. Diseases of the respiratory organs occupy the first ranked place in the structure of the incidence of children, reaching 50-75 % in the regions of Ukraine. The prevalence of the syndrome of bronchial hyperactivity increases . Objective: to study the effectiveness of nebulizer therapy for relief of acute bronchial obstruction syndrome in children with exacerbation of recurrent bronchitis or bronchial asthma. Materials and methods. 52 children of school age with acute bronchial hyperactivity (recurrent bronchitis – 28, bronchial asthma – 24) were examined. Two groups were formed by randomization: the main group (27 children) and the control group (25 children). Both groups were representative by sex, age, nosological diagnosis and severity of the disease. All children received basic therapy with topical glucocorticosteroids by nebulization. Children of the main group received intensive treatment by salbutamol inhalation during the first treatment day, and on 2–5 days as in the control group only 3 times a day. Children of the control group received inhalations together with intravenous drip infusions of euphyllin and dexamethasone. Results. In both groups, there was a dynamic regression of cough and sputum excretion, but in the main group, the rate of disappearance of cough by the 5th day of treatment was 3 times, and by the 10th day – 2,3 times higher, than in the control (p < 0.05); the rate of disappearance of sputum within 10 days is 1,7 times higher, respectively (p <0.05). Positive changes were confirmed by an auscultative pattern, the normalization of which occurred earlier for 1 week in patients receiving intensive nebulization bronchodilator therapy during the first day of the treatment. Conclusions. Competent use of nebulizers allows to increase the effectiveness of treatment of children with acute bronchial obstructive syndrome. Early relief of bronchospasm promotes faster normalization of inspiratory flow and respiration recovery. As a result, the terms of recovery and length of stay of children in the hospital are shortened.

Vasodilatory effect of L-arginine on isolated rabbit and human posterior ciliary arteries in vitro and increased optic disc blood flow in vivo.

This study aimed to clarify the vasodilatory effect of L-arginine on isolated rabbit and human posterior ciliary arteries (PCAs) and to investigate changes in optic disc blood flow after an infusion of L-arginine in vivo. Vascular ring segments were mounted on a double myograph system. After obtaining maximal contraction following administration of high-K solution, L-arginine was administrated. Six volunteers received an intravenous drip infusion of 100ml of L-arginine or saline. Changes in optic disc blood flow were measured by laser speckle flowgraphy. L-arginine relaxed high-K solution-induced contracted rabbit PCAs. Carboxy-PTIO (nitric oxide scavenger) and L-NAME (nitric oxide synthase inhibitor) inhibited L-arginine-induced relaxation in rabbit PCAs. After removal of the endothelium of the rabbit PCAs, L-arginine still relaxed rabbit PCAs. L-arginine relaxed human PCAs, despite the lack of nitric oxide production. In the L-arginine infusion group, the mean blur rate was significantly greater than that of the control group in vivo. L-arginine has both nitric oxide-dependent and independent vasodilatory effect on high K- induced contractions in isolated rabbit and human PCAs. L-arginine increased optic disc blood flow in vivo.

P7-1 - Home Medical Care Support for Patients With Left Ventricular Assist Device Using Social Networking Service

Continuous-flow left ventricular assist devices (CF-LVAD) are increasingly used to support for the patients with advanced heart failure as bridge to heart transplantation. However, various complications management is necessary for patients at home after discharge. For two patients needed treatment for driveline infection site, we started management using Social Networking Service (SNS), evaluate the pictures taken by patients themselves, sharing how to care of wound site with visiting nurses. Subsequently, multidisciplinary medical staff such as Certified Nurse, Clinical Engineer, Wound Ostomy and Continence Nurse and Collaborating hospital doctor participated, we have started comprehensive VAD management including not only wound management but also anticoagulant therapy and device management. On the screen used only by medical staff, we can share patient condition smoothly anywhere and discuss treatment strategies with all staff. When a patient's device failure or pump thrombus was suspected, we instructed the patient an emergency visit, exchanged controller and adjusted acute phase anticoagulant therapy in short-term hospitalization. Then patient continued drip infusion at home care and collaborating hospital, performed safe anticoagulant therapy by measuring INR themselves every other day and adjusting the medication using SNS. Discussion: By using SNS, we could share more medical information and provide appropriate support system, which led to support of patient self-monitoring and to maintain both safety and quality of life.

Successful Treatment with Metronidazole Intravenous Drip Infusion for Tetanus in Japan

Successful Treatment with Metronidazole Intravenous Drip Infusion for Tetanus in Japan

Preoperative evaluation of accessory hepatic ducts by drip infusion cholangiography with CT

BackgroundThis retrospective study aimed to investigate the incidence of each type of accessory hepatic duct by drip infusion cholangiography with CT (DIC-CT).MethodsFive hundred sixty nine patients who underwent preoperative DIC-CT and laparoscopic cholecystectomy were reviewed. Accessory hepatic ducts were classified as follows: type I (accessory hepatic ducts that merged with the common hepatic duct between the confluence of the right and left hepatic ducts and the cystic duct confluence), type II (those that merged with the common hepatic duct at the same site as the cystic duct), type III (those that merged with the common bile duct distal to the cystic duct confluence), type IV (the cystic duct merged with the accessory hepatic duct), and type V (accessory hepatic ducts that merged with the common hepatic or bile duct on the left side).ResultsAccessory hepatic ducts were observed in 50 patients. Type I, II, III, IV, and V accessory hepatic ducts were detected in 32, 3, 1, 11, and 3 patients, respectively. Based on their drainage areas, the accessory hepatic ducts were also classified as follows: a posterior branch in 22 patients, an anterior branch in 9 patients, a combination of posterior and anterior branches in 16 patients, a left-sided branch in 2 patients, and a caudate branch in 1 patient. None of the patients with accessory hepatic ducts suffered bile duct injuries.ConclusionThere are a number of variants of the accessory hepatic duct. DIC-CT is useful to detect the accessory hepatic duct.

Gastrostomy in patients with prion disease

ABSTRACTPatients with prion diseases can live for long periods of time in a state of akinetic mutism given appropriate management of their symptoms. To study symptom support in these cases, we performed gastrostomies on 3 patients with V180I genetic Creutzfeldt-Jakob disease (CJD) who had become akinetic and mute, and compared them to 14 other similar patients being fed by tube. In the 3 gastrostomy cases, there were no direct complications due to the gastrostomy or tube feeding, nor were there episodes of discontinuation of tube feeding or initiation of continuous drip infusion due to severe complications. Antibiotics were administered for mild infections, a complication of CJD, with 0.2% and 8.8% of the total time after gastrostomy being used for intravenous or transluminal administration, respectively. We compared the present patient series with that of our previous report statistically, and found that patients undergoing gastrostomy required significantly fewer discontinuations of tube feeding than those who did not. No significant difference in antibiotic administration was found between groups, however. It is our conclusion that gastrostomy should be allowed for symptom support in akinetic patients with prion disease, but adequate informed consent must be provided to the patient's family.

Comparative Dynamics of EEG Parameters in Elderly Patients with Depression during Monotherapy and Combined Treatment

Objective. To perform a comparative analysis of changes in the functional status of the brain by quantitative electroencephalography (EEG) during combined antidepressant treatment (venlafaxine and Cerebrolysin) and monotherapy (venlafaxine) of elderly patients with depression. Materials and methods. A total of 40 patients aged 60–79 (mean 67.1 ± 5.7) years took part in the study and were randomized to two groups. Patients of group 1 received venlafaxine at a dose of 75–150 mg/day for four weeks. Patients of group 2 received venlafaxine for four weeks along with Cerebrolysin (20 i.v. drip infusions of 20.0 ml in 100 ml of isotonic NaCl solution). Results and discussion. Both groups of patients noted signifi cant improvements in status by the end of treatment courses in terms of clinical assessment and the HAMD-17, CGI-S, CGI-I, and MMSE scales. Quantitative EEG studies showed that combined therapy with venlafaxine and Cerebrolysin in patients of group 2 led to more marked improvements in the functional state of the brain (increases in spectral power and normalization of the frequency of the parietal-occipital α rhythm) than seen in patients of group 1, who received monotherapy with venlafaxine.

A Novel Approach to Maintain the Real Time Instantaneous Data from Patient Using Ultra Low Power Micro Controller

Today’s web based technology offers many online services in almost every field to communicate and share resources [2], [3]. The web technology overcomes the disadvantage of GSM in which the numbers of messages are limited. The advantage of web technology is that we can send N number of information over the medium .The idea of this paper is patient monitoring system using embedded, networking and cloud computing [4], [5]. It maintains a database of all the patients admitted in the hospital [6], [7], [10], [11]and monitor the Intravenous Infusion pumps drip level and the biological parameters such as heartbeat, body temperature and updating the status[1], [12], [13]. If critical condition is determined it send alert to the analyst of that hospital. The alert contains the data which are listed above. The system is intended to reduce the manual intervention to the most possible levels. The cloud computing helps to maintain the data base in every second [8]. Keywords: MSP 430, Intravenous infusion drip rate, heartbeat, temperature, cloud computing, web technology

DIC–CTが有用であった鈍的外傷による総胆管完全断裂の1例(A case of complete transection of the common bile duct due to blunt abdominal trauma in which DIC–CT was useful for diagnosis)

要旨症例は19歳の女性。軽自動車運転中に受傷した。腹部造影CTで少量の腹腔内貯留液を認め，肝・膵損傷が疑われた。全身状態は安定しており，保存的加療とした。入院後，症状は徐々に改善し，第7病日より経口摂取を開始した。その後腹部膨満が増強し，第10病日の腹部CTにて腹水が著明に増量していた。腹水穿刺では胆汁様であり，DIC–CTにて下部胆管損傷が確認されたため，手術を施行した。術中所見から総胆管断裂と診断し，胆管空腸吻合を施行した。その後第26病日に軽快退院となった。鈍的腹部外傷による総胆管損傷は，特異的な所見に乏しく，診断が遅れることがある。本症例では，DIC–CTが診断に有効であった。

Usefulness of 3D balanced turbo-field-echo MR sequence evaluating the branching pattern of the intrahepatic bile ducts: comparison with drip infusion CT cholangiography.

For liver surgery, it is crucial to preoperatively examine the course of the right posterior bile duct. While MR cholangiopancreatography (MRCP) can only visualize the bile ducts, 3D balanced turbo-field-echo (BTFE) sequence clearly depicts the bile ducts and portal veins as well as drip infusion CT cholangiography (DIC-CT), without contrast media. We evaluated whether BTFE could substitute for DIC-CT. Thirty patients undergoing MRCP and BTFE on 1.5-T MR and DIC-CT were evaluated. Two readers retrospectively evaluated the branching pattern (supra-type: A-C or infra-type: D-E) and scored the degree of confidence and motion artifacts using a 3-point scale for the three 2-mm-thick reconstructed images. The bile duct diameter did not differ between DIC-CT and MRCP (p=0.07). Five patients (17%) had intrahepatic biliary dilatation (>3mm). The A, B, C, D, and E types were diagnosed in 21, 6, 1, 1, and 1 patient, respectively (28 supra-types and 2 infra-types) on DIC-CT. For DIC-CT, MRCP, and BTFE, the mean motion artifact scores were 3.0/3.0, 2.7/2.6, and 2.9/2.8, respectively. The mean diagnostic confidence scores were 2.9/2.9, 2.4/2.4, and 2.9/2.8, respectively, with no difference between DIC-CT and BTFE. The concordance between DIC-CT and BTFE was high (infra- or supra-type: κ=1.00/1.00, A-E: κ=0.86/0.66), but it was poor between DIC-CT and MRCP (infra- or supra-type: κ=0.35/-0.05, A-E: κ=0.33/0.41) for both readers. Similar to DIC-CT, the BTFE MR sequence had high diagnostic accuracy regarding the branching pattern of the intrahepatic bile duct, especially for the supra/infraportal type.

Pharmacokinetics of Standard- and Reduced-Dose Recombinant Human Soluble Thrombomodulin in Patients with Septic Disseminated Intravascular Coagulation during Continuous Hemodiafiltration.

Recombinant human soluble thrombomodulin (rTM) is reportedly excreted by the kidneys; therefore, the recommended dose for patients with renal impairment is one-third of the standard dose. The aim of this study was to evaluate whether this reduced dose of rTM achieves effective drug concentrations that are comparable to those of the standard dose in treating sepsis-induced disseminated intravascular coagulation (DIC) during continuous hemodiafiltration (CHDF). Eight patients in an intensive care unit were randomized to receive either reduced-dose (0.02 mg/kg, n = 4) or standard-dose (0.06 mg/kg, n = 4) rTM. We evaluated the effect of standard dose in comparison to that of reduced dose on the pharmacokinetics (PKs) of rTM for the sepsis-induced DIC patients receiving CHDF. Patients received rTM during a 30-min infusion for six consecutive days. PK parameters of rTM were analyzed using the one-compartment model. The elimination half-life, clearance (T1/2), and distribution volume of sTM were similar between the reduced and standard doses. The maximum concentration (Cmax) and area under the concentration-time curve (AUC) of sTM were approximately 2.5 times higher with standard-dose daily infusions than that with reduced-dose drip infusions (p = 0.041 and 0.062, respectively). The time when the blood concentration of sTM was >500 ng/mL, i.e., the holding time, was significantly longer with standard-dose infusions than those with reduced dose (p = 0.039). rTM displayed dose-dependent PK behavior at clinically relevant doses. During CHDF, effective blood concentration of rTM was not achieved with the reduced dose, and rTM was found to not bioaccumulate. Therefore, this pilot study suggests that reducing the rTM dose is unnecessary, even in sepsis-induced DIC patients who require CHDF. However, we need to perform a definitive study to determine the dosage of rTM for the case.

P273 Prediction of treatment response in Crohn's disease patients using contrast enhanced ultrasound: a pilot study

Background: Increased vascularity of the bowel wall is an early pathologic change that occurs in patients with active Crohn's disease (CD) and is used in imaging methods with intravenous contrast. We investigated whether a baseline contrast-enhanced ultrasound (CEUS) can differentiate responders from non-responders treated medically over a period of 6 to 12 months. Methods: Unselected adult CD patients from a tertiary care IBD center were recruited. Baseline demographic and clinical data was gathered and CEUS was performed at baseline in patients using a second-generation US microbubble contrast agent (Definity®) using 0.2 ml as bolus followed by drip infusion at a fixed rate. Following placement of an ROI (region of interest) over the bowel wall, perfusion analysis software modeled time-intensity curves (TIC) and relative kinetic perfusion parameters were measured. In each patient, clinical activity, treatment and therapeutic outcome were assessed at 3, 6 and 12 months after the CEUS. Treatment changes after baseline, systemic steroid dependency, ongoing clinical activity, new disease complications and need for surgery during the observation period were considered treatment failures. CEUS parameters were compared in patients with active (aCD) versus inactive CD (aCD) at baseline and in patients with favorable versus poor outcome at 3, 6 and 12 months post CEUS. Results: Twenty-one patients (9 men, median age 32 years, median disease duration 13 years; 15 aCD and 12 with previous surgery) were recruited. Baseline kinetic CEUS parameters peak systolic velocity (PSV-wash in rate) & wash in/wash out area under curve (WiWoAUC) in bolus and drip infusion differed significantly in aCD (n=15) versus iCD patients (n=6), while there was no difference in bowel wall US features including peristalsis, vascularity, layers loss, submucosa echogenicity nor in CRP levels between the two groups (Table 2). At baseline, 8 patients were started on a new treatment or were escalated and 5 of them were non-responders at 6 months. There was a trend towards higher median values in baseline CEUS kinetic parameters (PSV and WiWoAUC) in responders versus non-responders (Table 2). Conclusions: CEUS is a potentially useful, non-invasive tool to identify patients with active CD and who are more likely to respond to therapy.

術前DIC-CTにて低位合流肝管を伴う肝外胆管走向異常と診断した2例

今回われわれは，術前に肝外胆管走向異常を正確に診断し，安全に手術しえた2例を経験したので報告する．症例1は76歳の女性で，穿孔性虫垂炎術後に急性胆石胆嚢炎を発症した．症例2は59歳の男性で，健診で胆嚢腺筋症を指摘され当院に受診された．2例とも術前DIC-CTで左右肝管低位合流部に胆嚢管が合流する肝外胆管走向異常と診断され，腹腔鏡下胆嚢摘出術が施行された．術中胆管損傷の予防のために順行性胆嚢摘出術を施行し，術中・術後合併症は認めなかった．胆嚢摘出術における術中胆管損傷は比較的稀な合併症ではあるが，胆道系には様々な走向異常があるため，術前の画像診断による胆管像の把握は重要である．DIC-CTは簡便かつ非侵襲的な検査であり，腹腔鏡下胆嚢摘出術の術前検査として非常に有用であった．

開胸術後におけるアセトアミノフェン定時点滴注入併用フェンタニル持続静脈内注射による鎮痛効果の検討

目的）開胸術後鎮痛において，アセトアミノフェン定時点滴注入（点注）併用フェンタニル持続静脈内注射（静注）が硬膜外麻酔を代替する可能性を探求した．

Medical Treatment and Ramadan Fasting amongst Malaysian Muslim Medical Staff

The level of knowledge about Ramadan fasting and medical treatment amongst Medical staff has not been documented. This study assessed the level of knowledge amongst Malaysian Muslim Medical staff regarding this issue. Methodology: Questionnaires were distributed to 24 Muslim Medical Staff volunteers. The level of knowledge was evaluated based on the percentage of correct answers given by the respondents. Results: Most of the respondents understood that the use of inhaler, drip infusion, injection, ear, eye and nose drops and the use of sublingual tablets for medical purposes do not break the fast. Conclusion: The majority of respondents are knowledgeable on the issue of Ramadan fasting and Medical treatment.

Clinical Application of the Dried Blood Spot Method in the Measurement of Blood Busulfan Concentration

The dried blood spot (DBS) method, which is a simple technique for blood sample processing involving the placement of a drop of whole blood onto filter paper, has been used recently in clinical pharmacology to determine blood concentrations of various drugs. This study examined the feasibility of the clinical application of the DBS method for individual busulfan dose adjustments. Pharmacokinetic (PK) parameters of blood samples for busulfan measurements determined using the DBS method were compared with those using plasma separation (the conventional method). Blood samples were collected from patients receiving i.v. busulfan as a conditioning regimen before allogeneic hematopoietic stem cell transplantation at Toranomon Hospital, Japan. Samples collected 2, 4, and 6 hours after the start of the first drip infusion were processed by DBS or the conventional method. The area under the blood concentration-time curve (AUC) and other PK parameters were calculated to compare the 2 methods. Divergence of <20% in each parameter was considered acceptable. The divergence range for each parameter was as follows: blood concentration at 2 hours after the start of drip infusion, .6 to 8.2%; at 4 hours, .3 to 10.0%; at 6 hours, .3 to 14.2%; and AUC0–∞, .0 to 10.3%. None of the PK parameters showed a divergence between the DBS method and the conventional method exceeding 20%, suggesting that both methods are well correlated. The clinical application of blood sample processing with the DBS method in the measurement of blood busulfan concentration may therefore be feasible, but further studies are needed to confirm these findings.

Significance of imaging modalities for preoperative evaluation of the pancreaticobiliary system in surgery for pediatric choledochal cyst.

Roles of magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), drip infusion cholangiography with computed tomography (DIC-CT), and intraoperative cholangiopancreatography (IOCP) in visualizing pancreaticobiliary anatomy for pediatric choledocal cyst (CC) operations were examined. From 1980-2013, 117 pediatric CC patients (median age, 3years) underwent hepaticojejunostomy at our institution, with imaging modalities of ERCP (n = 81 over 34years), MRCP, DIC-CT, and IOCP (n = 45, 20, and 45 cases over the last 12years). First, visualization rates for pancreaticobiliary maljunction (PBM), common bile duct (CBD), pancreatic duct (PD), and intrahepatic bile duct (IHBD) were investigated. Sensitivity, specificity, and accuracy for detecting hepatic duct stricture were then compared between MRCP and IOCP. Visualization rates of PBM, CBD, PD, and IHBD were 57%, 100%, 64%, and 100% for MRCP; 82%, 77%, 95%, and 32% for ERCP; 25%, 75%, 21%, and 85% for DIC-CT; and 87%, 100%, 87%, and 100% for IOCP, respectively. Combination of MRCP and IOCP achieved rates of 89%, 100%, 91%, and 100%, respectively. Sensitivity, specificity, and accuracy for detecting stenosis were 86%, 68%, and 71% for MRCP, and 100%, 89%, and 91% for IOCP, respectively. Combining MRCP and IOCP can provide satisfactory pancreaticobiliary anatomical information for surgical planning for pediatric CC, with hepatic duct strictures evaluated more accurately by IOCP.

Comparison of intravenous hydralazine-bolus dose versus continuous infusion drip in Eclampsia

The leading cause of maternal death from eclampsia is cerebral hemorrhage, which is presumably the consequence of severe hypertension, so the acute elevations in blood pressure above 160/100 mm Hg should be brought under control. A study of forty diagnosed cases of eclampsia was carried out in Lady Willingdon Hospital, Lahore to determine the time and quantity of drug required to control high blood pressure levels by intravenous hydralazine bolus dose versus continuous infusion drip. Patients were divided into control and case group. In control group continuous infusion was given and in cases bolus dose was given. Mean time taken to control blood pressure by continuous infusion was 124.75 minutes and drug quantity was 23.50 mg while it was 52 minutes and 12.25 mg in case of bolus method. The study showed that 60-70% less time was required and 37.5-50% less drug quantity was used in bolus method versus continuous infusion of intravenous hydralazine. Regarding efficacy of intravenous hydralazine, it was fou nd to be statistically superior in this study (P&lt;0.05) so that management strategy should be changed in favour of bolus dose as compared to continuous infusion of intravenous hydralazine.

Wybrane metody preindukcji i indukcji porodu stosowane w krakowskich szpitalach

Introduction. The contemporary medical science provides various methods of labour induction: labour pre-induction and induction, which are determined by the obstetric situation and cervical ripening. A number of factors influence the effectiveness of labour induction and pre-induction. The choice of a suitable method should be guided by the well-being of the mother and child. Aim. Evaluation of selected labour pre-induction and induction methods pharmacological and non-pharmacological used in Krakow hospitals. Material and methods. The study included 271 patients admitted to Cracow hospitals to undergo childbirth, in whom various methods of labour pre-induction and induction were used. Diagnostic survey method was applied in the study, the tool being an original questionnaire used to analyze medical records. The statistical analysis was done with IBMSPSS Statistics version 19.0. Results. 92.2% of patients who received oxytocin infusion drip and 83.3% of patients who received oxytocin infusion drip with the Foley catheter felt pain. In the other groups the proportion was below 50%. The observed differences between the groups were statistically significant (p < 0.001). In examining the impact of the methods used on the way childbirth was completed, in multivariate logistic regression model, statistical significance of none of the analyzed method was confirmed. Conclusions. The results indicate that labour pre-induction and induction which applies the selected methods is effective in physiological childbirth induction and all the methods are, to a similar extent, safe for mother and child. Nursing Topics 2015; 23 (4): 496–501