Portable Pump Research Articles

Enteral levodopa/carbidopa gel infusion for the treatment of motor fluctuations and dyskinesias in advanced Parkinson’s disease

Pharmacotherapy designed to alleviate the symptoms of Parkinson’s disease is focused on the stimulation of striatal dopamine receptors. The ideal pharmacological treatment would involve continuous dopaminergic stimulation. Currently, the most effective pharmacotherapy available is levodopa delivered orally; however, its short plasma half-life in combination with erratic gastric emptying and intestinal absorption makes dopaminergic stimulation pulsatile. Motor fluctuations and dyskinesias develop with time as a consequence and can become disabling. A gel formulation of levodopa/carbidopa has been developed for enteral (duodenal or jejunal) infusion via a portable pump. The infusion provides smooth plasma levodopa levels, more continuous dopaminergic stimulation and effective treatment of motor complications.

Portable pumps primed for by-pass pumping

When major wastewater system upgrades commence, underground contractors often need assistance on projects to temporarily divert fluids from one source to another. Contractors and municipalities find portable pump rentals a cost-effective and efficient solution when conducting by-pass projects from repairing sewer lines to replacing force mains or performing maintenance at wastewater treatment plants. Here, Gentry Baumline of Thompson Pump discusses the main elements of a successful by-pass operation.

Preoperative radiation in combination with uracil/tegafur (UFT) and mitomycin C (MMC) in locally advanced rectal adenocarinoma

13512 Background: Preoperative chemoradiation has become the standard treatment approach not only for tumor downstaging, but also for adjuvant treatment of locally advanced rectal adenocarcinomas (Sauer et al. NEJM 2004). The most commonly used chemotherapeutic agent with preoperative radiation is either bolus or infusional 5-fluorouracil (5-FU). These combinations produce pathologic complete responses in the range of 10–30%. Continuous infusion of 5-FU has proven to be superior to bolus 5-FU, when given during radiation. However widespread use of continuous infusion 5-FU has been limited by the need for an indwelling venous catheter and portable infusion pump. UFT acting like infusional 5-FU, offers the advantage of oral administration. Response to preoperative chemoradiation is associated with higher sphincter preservation and survival rates. UFT, MMC (a hypoxic cell cytotoxin) combination during preoperative radiation may improve the response rates. The aim of this study is to assess the efficacy (pCR) and toxicity of this combination. Methods: 26 patients with biopsy proven non metastatic rectal adenocarcinoma were included. Clinical T and N stages, determined by pelvic MRI were; 10/26 cT3, 16/26 cT4, 10/26 cN0, and 16/26 cN+. Pelvic radiotherapy was administered with 6 or 15 MV photons to 46 Gy in 23 fractions over 5 weeks, with four field technique in prone position. During radiotherapy, patients received UFT, 300 mg/m2 divided in two daily doses, five days a week, from Monday to Friday, starting on the first day, ending on the last day of radiation, together with bolus injection of MMC, 10 mg/m2, once in the morning of the first day of radiaton. Surgery was performed 6 or more weeks after the radiation treatment has ended. Results: Acute grade III/IV toxicity was observed in 6 out of 26 patients. Diarrhea, 3 grIII, 1 grIV. Neutropenia, 1 grIII. Dermatitis, 1 grIII. Tumor downstaging was observed in 16 patients out of 26 (62%). Nodal sterilization was obtained in 11 patients out of 16 (69%), with a pathologic complete response in 3 out of 26 patients (11%). Conclusions: Preoperative radiation concurrent with UFT and MMC has a good activity, with manageable acute toxicity. No significant financial relationships to disclose.

Traitement des surinfections bronchiques: stabilité des antibiotiques dans les diffuseurs portatifs

AbstractTreatment of Bronchial Superinfections: Data Related to Stability of Antibiotics in Portable Pumps. Introduction.Given many data about the stability of antibiotics in portable pump (elastomer) are lacking, this study was designed to make a point about available data and to evaluate the stability of antibiotics when exposed to temperature within 35°C (average temperature measured in real conditions of use). Material and methodsFirst, to collect information about the stability of antibiotics in portable pump and to confront them with the local antibiotics protocols dedicated to the treatment of bronchial superinfection in patients with cystic fibrosis; second, to evaluate the stability of piperacillin associated with tazobactam at 35°C. ResultsWhile measured concentrations in tazobactam did not show significant variation during the study, piperacillin measurements showed a major reduction of concentration (up to 33%), both time and concentration related to. DiscussionSuch information must be pointed out to prescribers and patients to ensure a cold accumulator is placed in the pump can’ying-bag and to limit the duration of infusion to 24h with a single pump. ConclusionThis experimental program will keep on going with the stability study of both ticarcillin and cefsulodin in portable pump.

Use of continuous subcutaneous insulin infusion by a portable insulin pump during pregnancy in women with type 1 diabetes mellitus

Diabetes mellitus is associated with an increased risk for neonatal morbidity and mortality. One of the most important goals in treating pregnancies complicated with diabetes is keeping glucose level within the normal range, especially in the first trimester. A portable insulin pump for continuous subcutaneous insulin infusion (CSII) represents the best form of therapy for patients with type 1 diabetes mellitus during pregnancy. The aim of our study was to evaluate the effects of therapy with a portable insulin pump for continuous subcutaneous insulin infusion during the first trimester of pregnancy on the quality of glycoregulation and pregnancy outcome in women with type 1 diabetes mellitus. A total of 17 newly diagnosed pregnant women with type 1 diabetes mellitus were treated with CSII therapy for three months. The parameters of glycoregulation (hemoglobin A, glycosylated--HbAlc, mean blood glucose value in daily profiles--MBG, daily requirement for insulin--IJ/kg BM), lipid levels, blood preassure and renal function were estimated before and after the therapy. These parameters were correlated with parameters of pregnancy outcome: fetal weight, APGAR score, duration of pregnancy. There was a significant improvement in HbA1c (8.94 +/- 1.62 vs. 6.90 +/- 1.22 %,p < 0.05), MBG (9.23 +/- 2.22 vs. 6.41 +/- 1.72 mmol/l, p < 0.01), and daily requirement for insulin (0.66 +/- 0.22 vs. 0.55 +/- 0.13 IJ/kg BM, p < 0.05) during the CSII therapy. There were significant correlations between fetal weight and HbAlc (r = -0.60, p < 0.05), triglyceride levels (r = -0.63, p < 0.01), and the number of pregnancies (r = -0.62, p < 0.01), as well as between APGAR score and MBG (r = -0.52, p < 0.05) and cholesterol levels (r = -0.65, p < 0,01) before a portable insulin pump was applicated. There was a significant improvement in the quality of glycoregulation during CSII therapy in the pregnant women with type 1 diabetes mellitus. The quality of glycoregulation in the moment of conception was the important factor for pregnancy outcome.

Satisfaction and Convenience of Chelation Therapy in Patients with Sickle Cell Disease (SCD): Comparison between Deferasirox (Exjade®, ICL670) and Deferoxamine (DFO).

Introduction: Frequently transfused patients with SCD develop hemosiderosis, which, if untreated, results in multi-organ damage and early death. DFO is the only iron chelator (IC) approved by the FDA and is injected subcutaneously over 8–12 hours/day, 5–7 days/week. However, adherence to this therapy is difficult for patients. This report summarises patient satisfaction with deferasirox (DSX), an oral IC in development, compared to DFO in an open-label Phase II trial.Methods: A total of 195 patients with SCD were randomized and treated with DSX (n=132) or DFO (n=63). Seventy-four patients had not received IC at baseline, of whom 25 were randomized to DFO and 49 to DSX. DSX was taken orally once/day while DFO was infused via a portable pump over 8–12 hours/day, 5–7 days/week. Patient reported outcome data were documented, including satisfaction and convenience with treatment, and number of hours lost/month for taking IC. Patients with previous experiences of DFO reported preferences for DSX, DFO, or neither. At end-of-study (EOS), patients reported their willingness to continue taking the drug they were on.Results: At baseline, only 21% of patients previously treated with DFO reported that they were ‘very satisfied' or ‘satisfied' with DFO taken prior to the study, and only 16.5% reported that DFO was ‘very convenient' or ‘convenient'. Further, 77.1% of them preferred DSX. Reasons included: more convenient to take (38.6%), less disruptive to their day (18.1%), less sore (15.7%) and less disruptive to sleep (6.0%). Table 1 indicates the greater satisfaction and convenience experienced by those on DSX versus DFO regardless of chelation status at baseline. At EOS, significantly more patients on DSX (84.3%) indicated they would be willing to continue DSX, compared to 10.5% of patients on DFO. Similarly, patients reported that time lost due to taking DSX ranged from 0.2–2.9 hours/month, while time lost due to taking DFO ranged from 3.2–37.4 hours/month.Table 1Satisfaction and Convenience in Patients Previously Treated with DFO versus Treatment Naïve PatientsDSXDFOPrevious DFOTreatment naïvePrevious DFOTreatment naïveVery Satisfied or Satisfied, %Wk 285.573.523.724.0Wk 1289.263.342.136.0Wk 2486.769.439.832.0EOS84.359.223.724.0Very Convenient or Convenient, %Wk 279.573.515.832.0Wk 1283.171.436.824.0Wk 2479.571.434.224.0EOS79.563.318.420.0Conclusions: Results suggest satisfaction and convenience scores are significantly higher, and the impact on daily activities is less, for patients on DSX than those on DFO. Further studies are needed to explore whether higher satisfaction and convenience will lead to better adherence to DSX. As adherence to chelation therapy impacts on survival in transfusion-dependent patients with SCD, these data indicate that DSX may significantly improve the care of transfusion-dependent patients.

Patient-Controlled Analgesia

Using a portable infusion pump, intravenous opioid patient-controlled analgesia (PCA) permits a patient to self-deliver a small bolus of opioid to achieve prompt relief without over sedation. Use of PCA for pain management is increasing in hospitals, largely because it can provide equivalent or better analgesia than conventional nurse-administered opioid analgesia, and patients are more satisfied with its use. There is no decisive pharmacological or clinical argument for the choice of one opioid rather than another. Thus, morphine remains the most frequently used opioid in PCA. The adjunction of non-opioid drugs to morphine in the PCA reservoir is still very controversial. A new investigational PCA transdermal system using iontophoresis to deliver fentanyl seems to provide an adequate pain control with the advantages of needle-free, preprogrammed, self-contained device. Whatever drug or device used, the overall success of the PCA technique relies mainly on the expert supervision of nurses or anesthesiologists in an Acute Pain Service. Indeed, PCA is effective and significant only on the condition that there is careful preoperative patient education and strict postoperative monitoring. In addition, preoperative patient selection allows to exclude patients with evidence of cognitive dysfunction or physical disabilities, making the use of the patient-controlled device impossible. Caution is required among patients with respiratory or renal insufficiency. In the future, the indispensable improvement in the management of postoperative pain should lead to a greater expansion of PCA. However, more pharmaco-economic evaluations will be needed on the cost-effectiveness issue.

Development of a sampling and flow injection analysis technique for iron determination in the sea ice environment

A trace metal clean method for sampling and analysis of iron is set up and applied to sea ice and its associated snow, brine, and underlying seawater sampled during the Antarctic expedition “ARISE in the East” (Antarctic Remote Ice Sensing Experiment, AA03-V1, September–October 2003, 64–65°S/112–119°E, RV Aurora Australis). For clean sampling, a non-contaminating electropolished stainless steel ice corer is designed in conjunction with a polyethylene lathe equipped with Ti chisels to remove possibly contaminated outer layers of ice cores. A portable peristaltic pump with clean tubing is used on the ice to sample the underlying seawater (interface ice–water = 0, 1 and 30 m) and sea ice brine from access holes. Considering the extreme range of salinities (1–100) and Fe concentrations (0.1–100 nM) previously observed in similar environments, it is of paramount importance to set up a simple and sensitive Fe analyser adapted to such gradients. We use a flow injection analysis (FIA) technique and successfully demonstrate its capability to measure Fe concentrations directly in the sample without an on-line preconcentration/matrix separation step. We test the sensitivity, accuracy, precision and long-term stability of the analytical procedure. Also we explore and remediate interferences from a suite of other trace elements, such as Ni, Cd, Cr, Mn, Cu, Zn and Co. Analysis of reference materials NASS-5 and CASS-3 gives a good agreement with the certified values. Repeated measurements over a period of 5 months of an “in-house” Antarctic seawater standard yields a concentration of 1.02 ± 0.07 nM ( n = 17, 1 σ). The detection limit (3 σ of the blank) is on average 0.12 nM. We report here results of the Fe distribution in sea ice that are in good agreement with previously published data. To our knowledge, this work provides the first complete profiles of total dissolvable and dissolved Fe in sea ice.

Selected Ion Monitoring – Gas Chromatography/Mass Spectrometry Determination of Halothane Fumes in Operating Theatres

Halothane vapour, used as an inhaled anaesthetic for narcosis, is released during surgical operations causing occupational exposure to medical staff and nurses. The current work continues the controversial issues related to the biological side effects of halothane, and gives a simple method for sampling and determining the air concentration of the anaesthetic in different rooms used for surgical operations. Air contaminants were collected on active charcoal, using a portable pump. Liquid extraction with toluene was followed by injection of the eluate onto a GC capillary column coupled to a quadrupole mass detector. The method was validated with respect to linearity, precision and accuracy. The concentration of halothane in the air was found to depend on room volume, air ventilation rate inside the theatres, and on the technical condition of the vaporiser and anaesthesia devices. Introduction

Recent acquisitions in the management of iron overload

Chronically transfused patients develop iron overload, which leads to organ damage and ultimately to death. The introduction of the iron-chelating agent desferrioxamine mesylate dramatically improved the life expectancy of these patients. However, the very demanding nature of this treatment (subcutaneous, continuous infusion via a battery-operated portable pump) has been the motivation for attempts to develop alternative forms of treatment that would facilitate the patients' compliance. In this review, we describe the most important advances in iron-chelation therapy.

Continuous Peripheral Nerve Blocks at Home: A Review

Postoperative analgesia is generally limited to 12-16 h or less after single-injection regional nerve blocks. Postoperative analgesia may be provided with a local anesthetic infusion via a perineural catheter after initial regional block resolution. This technique may now be used in the outpatient setting with the relatively recent introduction of reliable, portable infusion pumps. In this review article, we summarize the available published data related to this new analgesic technique and highlight important issues related specifically to perineural infusion provided in patients' own homes. Topics include infusion benefits and risks, indications and patient selection criteria, catheter, infusion pump, dosing regimen, and infusate selection, and issues related specifically to home-care.

Mandibular elongation by automatic distraction osteogenesis: The first application in humans

We report the case of a 65-year-old man who was the first person to have the right ramus of his mandible lengthened by 20 mm by automatic continuous distraction osteogenesis. The device consists of two units: a component that is implanted into the bone, and an external component that is distant from the surgical site and mounted on a battery-driven portable syringe driver or infusion pump. A non-compressible drive cable connects the two.

Adverse event reporting: making the system work.

111 Anurse inadvertently connects a blood pressure cuff to an intravenous line, pumping the patient full of air. A portable infusion pump delivers the wrong dose of medication. An arthroscopic irrigation pump shoots fluid with too much pressure, permanently damaging a patient’s knee. In each case, a patient was injured or killed because of mistakes involving medical devices. Such incidents are not as rare as we’d like to think. An Institute of Medicine report published in 2000 estimated that up to 98,000 people die in hospitals each year as a result of medical mistakes. Approximately 1% to 2% of these cases involve medical devices. The FDA is informed of approximately 100,000 malfunctions of medical devices each year. Adverse event reporting is one strategy that has been used to learn from the mistakes that people make and the equipment failures that occur. “The first rule of medicine is to do the patient no harm,” says Marvin Shepherd, PE, a clinical engineer and accident investigator with Devteq Publishing and Consulting. “The goal in investigating an incident and reporting on the results of that investigation is to make corrections to prevent it from ever happening again.” Matt Baretich, PE, PhD, a clinical engineer and accident investigator with Baretich Engineering, agrees. “People will always make mistakes, and there will always be human error. Our ultimate goal is to try to learn what we can to reduce the likelihood of mistakes.” What is the role of clinical engineers and biomedical equipment technicians in adverse event reporting? What can they do to become involved in the process and improve it? BI&T interviewed experts in the field and found that a great deal remains to be done to strengthen the role of clinical engineers and biomeds in the process and to improve the process itself.

Sewage bypass system utilises portable rental pumps

Sewage bypass system utilises portable rental pumps

January 25 Highlights

Ravina et al. describe how PET and SPECT imaging methods have been used as biomarkers in PD. The authors conclude that there are insufficient data to support the routine use of these imaging techniques as diagnostic tools or surrogate markers and suggest changes in the design and execution of future imaging studies. see page 208 In a randomized crossover trial in 24 patients with advanced Parkinson disease (PD), Nyholm et al. compared intraduodenal infusion of a levodopa/carbidopa gel with individualized conventional combination treatments. Infusion decreased “off” state, and increased “on” state without increasing dyskinesias; it also improved quality of life. see page 216 The accompanying editorial by M. Maral Mouradian notes that the search goes on for ways to stimulate striatal dopamine receptors pharmacologically in a sustained manner with a method that can be handled by parkinsonian patients and their caregivers. The Nyholm et al. study used a gel formulation that reduces the volume of infusion 10-fold, allowing it to be delivered with a portable pump, and eliminates the need for carbidopa. There …

Field Comparison of Tensiometer and Granular Matrix Sensor Automatic Drip Irrigation on Tomato

A low-volume/high frequency (LVHF) soil moisture-based drip irrigation system was tested on a shallow sandy soil at a commercial tomato (Lycopersicon esculentum) farm in southern Florida. Six LVHF irrigation treatments were compared with the standard commercial practice on the farm (control), where a portable pump was used for manual drip irrigation twice each week. In the six LVHF treatments the system was continuously pressurized by means of an electrical pump and a pressure tank, and controlled by an irrigation timer set to irrigate a maximum of five times per day with the irrigation time (i.e., volume) set according to historical evapotranspiration (ET) demands in the area. Two treatments were based on timer schedules, one to supply 100% of the maximum recommended crop water needs in the area based on historical ET (ET-100%), and the other to supply 150% of those needs (ET-150%). The other four treatments were created by interfacing two types of soil moisture sensors (switching tensiometers and granular matrix sensors with control modules) set at two moisture points (wet = 10 kPa, optimal = 15 kPa) in a closed control loop with the irrigation timer programmed at the ET-100% schedule. Results showed that the six LVHF treatments reduced water use while not significantly affecting tomato yields. Switching tensiometers at the 15 kPa set point performed the best (up to 73% reduction in water use when compared to the control, 50% with respect to ET-100%). The results show that water use below historical ET levels can be obtained without sacrificing yield by keeping the root zone moisture at controlled levels with the soil-moisture based system. Routine maintenance was critical for reliable operation of the switching tensiometers. Granular matrix sensor based irrigation behaved erratically, and did not improve water savings compared to ET-100%, indicating that this system was not effective under the conditions of the area due to the sensor's slow response to frequent wetting-rewetting cycles and characteristics of the interface.

AGA technical review on the clinical use of esophageal manometry

AGA technical review on the clinical use of esophageal manometry

An in situ toxicity identification evaluation method part I: Laboratory validation

Identification of individual chemical groups is critical in evaluating sediment quality and fractionating these groups of chemicals in a mixture is important to determine the primary chemicals causing toxicity. The in situ toxicity identification evaluation (iTIE) is a novel method that was developed to fractionate chemicals in contaminated sediments and waters and assess toxicity organisms. The study objectives were to verify that the iTIE can help identify contaminant chemical classes and improve the toxicity assessment process; and compare the iTIE and U.S. Environmental Protection Agency's (U.S. EPA) toxicity identification evaluation (TIE) methods. The iTIE exposure chamber is powered by a portable air pump that suctions pore water, via a Venturi system, through selective sorption materials. After passing through the sorptive materials, the pore water passes into an exposure chamber containing Daphnia magna. The chemical sorption materials included Ambersorb 563 for nonpolar organic chemical adsorption, Chelex for metals chelation, and multiple zeolite types for ammonia adsorption. The laboratory studies were performed using water and sediments spiked with ammonia, cadmium, and fluoranthene. The laboratory validation of the iTIE approach showed that different classes of compounds readily could be separated via the resin treatments, resulting in significant differences in concentrations and thus exposures to in situ exposed organisms. Ammonia, cadmium, and fluoranthene were significantly removed by zeolite, Chelex, and Ambersorb, respectively. Although there was some cross-adsorption to the other nontarget resins, it was limited and allowed for treatment differences to be detected. Survival in the treatment resins exposed to the target compounds was as high as control survivals. A 24-h exposure period appeared optimal, allowing for replacement of initial culture water with pore waters, while longer exposures occasionally allowed for breakthrough of contaminants. The iTIE was more sensitive than the U.S. EPA TIE method, in that it detected toxicity more readily due to the greater loss of contaminant concentrations in the TIE manipulation process.

Application of gonadotropin releasing hormone in hypogonadotropic hypogonadism--diagnostic and therapeutic aspects

Puberty is the result of reactivation of the gonadotropin releasing hormone (GnRH) pulse generator resulting in an increasing release of GnRH by the hypothalamus, which stimulates the gonadotropic cells of the pituitary to synthesize and secrete LH and FSH. Hypogonadotropic hypogonadism (HH) is often the result of GnRH deficiency. The clinical picture is characterized by the absence of pubertal development and infertility. It is difficult to differentiate HH from delayed puberty since low gonadotropin and low testosterone levels are found in both conditions. We hypothesized that long-term GnRH administration may differentiate between the two conditions by a difference in the increase of gonadotropins, the idea being that in normal delayed puberty the pituitary of the patient has been primed with GnRH during the fetal and early postnatal period. Seventeen adolescents suspected of having hypogonadotropic hypogonadism were treated with pulsatile GnRH for 7 days. At the present time, the diagnosis of these patients is known and the results of the long-term GnRH stimulation have been evaluated according to the present diagnosis. The results show that the increase in gonadotropins following GnRH treatment is similar in both conditions. Therefore, at a prepubertal age a normal delayed puberty cannot be distinguished from hypogonadotropic hypogonadism using long-term GnRH stimulation. Long-term pulsatile GnRH treatment is a physiological therapy for the induction of puberty. Unlike testosterone it has the advantage of stimulation of testicular growth and fertility, as well as virilization, in males. We have treated 68 male patients with HH with pulsatile GnRH. The results show testicular growth and virilization in all the patients and spermatogenesis in 58 patients. Wearing a portable pump is cumbersome. However, the patients were very motivated and adapted very easily to this inconvenience. When spermatogenesis had developed, GnRH treatment was changed to human chorionic gonadotropin (hCG) administration 1-2 times per week intramuscularly or subcutaneously. During hCG therapy spermatogenesis was maintained or even improved. At least ten patients fathered children. Pulsatile GnRH cannot distinguish between a normal delayed puberty and a hypothalamic defect in still prepubertal patients. Pulsatile GnRH offers an appropriate way to initiate testicular growth including virilization and fertility in males with hypogonadotropic hypogonadism.

Successful use of ketamine for intractable cancer pain.

GOALS AND WORK: Despite medical awareness, intractable pain is a serious problem in cancer and occurs in up to 2% of advanced cancer patients. However, few data are available concerning the optimal treatment of such patients. The emergence of intractable pain may notably be due to the activation of N-methyl-D-aspartate (NMDA) receptors located in the central nervous system. NMDA antagonists might thus be an interesting approach in such pain syndromes. Twelve patients with intractable cancer pain received a test dose of 5-10 mg of ketamine, a strong NMDA antagonist, in order to determine their response and tolerance to the drug. Continuous intravenous infusions of ketamine associated with morphine were then administered. The acute test dose was successful in all cases (VAS <3/10 after 5 min). The prolonged use of ketamine allowed us to reduce the total daily dose of morphine required (range: 200-1,200 mg) by 50% and allowed eight patients to go home with a portable pump with morphine and ketamine during a relatively long period of time (range: 7-350 days, median: 58 days). Side effects were moderate (dizziness) and they were limited to the test phase. Our data suggest the importance of NMDA receptors in the genesis of chronic cancer pain and indicate that NMDA antagonists should be further studied for the management of cancer pain and, in particular, intractable pain.