RESUMO
Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) is a promising approach with a high optimization potential for the treatment of peritoneal carcinomatosis. To study the efficacy of PIPAC and drugs, first rodent cancer models were developed. But inefficient drug aerosol supply and knowledge gaps concerning spatial drug distribution can limit the results based on such models. To study drug aerosol supply/deposition, computed tomography scans of a rat capnoperitoneum were used to deduce a virtual and a physical phantom of the rat capnoperitoneum (RCP). RCP qualification was performed for a specific PIPAC method, where the capnoperitoneum is continuously purged by the drug aerosol. In this context, also in-silico analyses by computational fluid dynamic modelling were conducted on the virtual RCP. The physical RCP was used for ex-vivo granulometric analyses concerning drug deposition. Results of RCP qualification show that aerosol deposition in a continuous purged rat capnoperitoneum depends strongly on the position of the inlet and outlet port. Moreover, it could be shown that the droplet size and charge condition of the drug aerosol define the deposition efficiency. In summary, the developed virtual and physical RCP enables detailed in-silico and ex-vivo analyses on drug supply/deposition in rodents.
Assuntos
Antineoplásicos/administração & dosagem , Neoplasias Peritoneais/tratamento farmacológico , Peritônio/diagnóstico por imagem , Aerossóis , Animais , Antineoplásicos/farmacocinética , Simulação por Computador , Desenho Assistido por Computador , Humanos , Hidrodinâmica , Injeções Intraperitoneais/instrumentação , Injeções Intraperitoneais/métodos , Modelos Animais , Neoplasias Peritoneais/diagnóstico por imagem , Neoplasias Peritoneais/metabolismo , Peritônio/metabolismo , Imagens de Fantasmas , Pressão , Ratos , Tomografia Computadorizada por Raios X , Interface Usuário-ComputadorRESUMO
BACKGROUND: In the last 20 years, intraperitoneal chemotherapy (IPC) has been explored as a modality for the management of peritoneal metastases of gynecologic, gastrointestinal, and primary peritoneal tumors. Direct delivery of chemotherapeutic agents to the peritoneal cavity space has proved superior to systemic chemotherapy when evaluating characteristics such as drug concentration reached in the peritoneal space, penetration into peritoneal metastases, and chemotherapy-related toxicity. Traditionally, IPC is delivered by peritoneal lavage with a liquid solution. This form of delivery has limitations, including inhomogeneous intraperitoneal distribution and limited ability to penetrate tissues and metastatic nodules. An alternative mode of delivery is so-called pressurized intraperitoneal aerosol chemotherapy (PIPAC). Within this context, the present study sought to identify the pattern of spatial distribution of therapeutic solutions aerosolized into the peritoneal space using a single-port PIPAC device and ascertain whether the aerosolized method is superior to the traditional (liquid) mode of IPC delivery. METHODS: Analysis of the rate of intra-abdominal staining with aerosolized 2% silver nitrate in five porcine models. RESULTS: Assessment of differences in stain impregnation between the upper, middle, and lower abdomen did not reveal significant differences (p = 0.42). The median sum scores were 1 for the upper abdomen and 3 for the middle and lower abdomen. CONCLUSIONS: Aerosolization does not reach all regions of the abdomen homogeneously. However, adequate exposure of the upper abdomen, mid-abdomen, and lower abdomen to chemotherapeutic agents can be achieved with PIPAC.
Assuntos
Antineoplásicos/administração & dosagem , Tratamento Farmacológico/instrumentação , Neoplasias Peritoneais , Cavidade Abdominal/patologia , Aerossóis/administração & dosagem , Aerossóis/farmacologia , Animais , Antineoplásicos/farmacologia , Tratamento Farmacológico/métodos , Desenho de Equipamento , Injeções Intraperitoneais/instrumentação , Injeções Intraperitoneais/métodos , Neoplasias Peritoneais/tratamento farmacológico , Neoplasias Peritoneais/secundário , Peritônio/efeitos dos fármacos , SuínosRESUMO
The precision of the delivery of therapeutics to the desired injection site by syringes and hollow needles typically depends on the operator. Here, we introduce a highly sensitive, completely mechanical and cost-effective injector for targeting tissue reliably and precisely. As the operator pushes the syringe plunger, the injector senses the loss-of-resistance on encountering a softer tissue or a cavity, stops advancing the needle and delivers the payload. We demonstrate that the injector can reliably deliver liquids to the suprachoroidal space-a challenging injection site that provides access to the back of the eye-for a wide range of eye sizes, scleral thicknesses and intraocular pressures, and target sites relevant for epidural injections, subcutaneous injections and intraperitoneal access. The design of this simple and effective injector can be adapted for a broad variety of clinical applications.
Assuntos
Sistemas de Liberação de Medicamentos/instrumentação , Sistemas de Liberação de Medicamentos/métodos , Injeções/instrumentação , Injeções/métodos , Animais , Sistemas de Liberação de Medicamentos/efeitos adversos , Desenho de Equipamento/instrumentação , Desenho de Equipamento/métodos , Olho/patologia , Humanos , Bombas de Infusão/efeitos adversos , Injeções/efeitos adversos , Injeções Epidurais/instrumentação , Injeções Epidurais/métodos , Injeções Intraperitoneais/instrumentação , Injeções Intraperitoneais/métodos , Injeções Subcutâneas/instrumentação , Injeções Subcutâneas/métodos , Agulhas , Coelhos , Seringas , Ferimentos e LesõesRESUMO
We report the first application of pressurized intraperitoneal aerosol chemotherapy (PIPAC) as a rescue therapy before palliative D2 gastrectomy combined with liver metastasectomy performed in a 49-year-old woman with peritoneal carcinomatosis who was primarily diagnosed with and underwent surgery for a Krukenberg tumor. The PIPAC procedure was performed with the use of cisplatin at 7.5 mg/m2 and doxorubicin at 1.5 mg/m2 for 30 min at 37 °C. Eight weeks after the PIPAC procedure, the patient underwent open classic D2 gastrectomy with the creation of a Roux-en-Y anastomosis (RNY) combined with liver metastasectomy. The patient underwent the classic protocol for chemotherapy combined with Xeloda. The patient felt better and returned to her daily activities. Multicenter data should be gathered to confirm the usefulness of PIPAC as a rescue or neoadjuvant supportive therapy in a very select group of patients who have been recently qualified to undergo classic chemotherapy or standard oncologic surgical procedures.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Tumor de Krukenberg/diagnóstico , Neoplasias Hepáticas/terapia , Terapia Neoadjuvante/métodos , Neoplasias Peritoneais/terapia , Aerossóis , Cisplatino/administração & dosagem , Erros de Diagnóstico , Doxorrubicina/administração & dosagem , Feminino , Gastrectomia/métodos , Hepatectomia/métodos , Humanos , Injeções Intraperitoneais/instrumentação , Injeções Intraperitoneais/métodos , Tumor de Krukenberg/cirurgia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Metastasectomia/métodos , Pessoa de Meia-Idade , Nebulizadores e Vaporizadores , Cuidados Paliativos/métodos , Neoplasias Peritoneais/diagnóstico , Neoplasias Peritoneais/diagnóstico por imagem , Neoplasias Peritoneais/patologiaRESUMO
In this study, we designed and developed a novel low-cost system for anesthetizing and injecting adult zebrafish. The system utilizes a gradual cooling method for the anesthesia and maintains the fish in a stable anesthetic plane, as well as stabilizes the animal so that intraperitoneal injections can be consistently performed. It is a system that any laboratory with access to a workshop can build for their group. Moreover, it is a safe system for researchers, as well as a reliable one for repeated experiments since multiple fish can be injected quickly and there is little physical contact necessary between the investigator and the animal. This will likely reduce any unnecessary stress in the fish, as compared with manual methods of injection. Finally, the system is adaptable so that as the investigators' procedural needs change due to different research questions, that is, gradual rewarming or something of that nature, it could be modified.
Assuntos
Anestesia/veterinária , Injeções Intraperitoneais/veterinária , Anestesia/economia , Anestesia/métodos , Animais , Injeções Intraperitoneais/economia , Injeções Intraperitoneais/instrumentação , Injeções Intraperitoneais/métodos , Peixe-ZebraRESUMO
Intraperitoneal (IP) injections are an effective and reproducible route of drug administration. However, current IP equipment can be either costly, inaccurate, or unsafe for zebrafish. We describe a simple, low-cost IP setup, which can be easily assembled from inexpensive and readily available parts, and which provides a safe, reproducible, and accurate IP-injection method for experimenters.
Assuntos
Comportamento Animal , Injeções Intraperitoneais/veterinária , Peixe-Zebra/crescimento & desenvolvimento , Animais , Desenho de Equipamento , Injeções Intraperitoneais/economia , Injeções Intraperitoneais/instrumentação , Injeções Intraperitoneais/métodosRESUMO
STUDY OBJECTIVE: To evaluate intraperitoneal ropivacaine delivery with the AeroSurge device in the clinical setting and to evaluate the total systemic ropivacaine levels achieved following delivery of 50 mg of aerosolized ropivacaine. DESIGN: Preliminary, prospective, nonrandomized study. SETTING: Operating room of a university hospital. PATIENTS: 5 consecutive ASA physical status 1 and 2 patients undergoing elective laparoscopic Nissen fundoplication or cholecystectomy. INTERVENTION: Five mL of 1% ropivacaine was delivered through the 10 mm port using the AeroSurge device at peritoneal insufflation. MEASUREMENTS: Venous blood samples were collected and total ropivacaine concentration was determined using liquid chromatography-mass spectrometry. MAIN RESULTS: The AeroSurge device delivered ropivacaine, visible as mist within the peritoneal cavity. Peak concentration (Cmax) was attained between 10 and 30 minutes following the end of aerosolized ropivacaine delivery. At no stage did any level approach toxic levels. CONCLUSIONS: This preliminary study confirms that aerosolized intraperitoneal local anesthetic is feasible, with ropivacaine concentrations remaining within safe levels.
Assuntos
Amidas/administração & dosagem , Anestésicos Locais/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Adulto , Aerossóis , Idoso , Amidas/sangue , Anestesia Local/métodos , Anestésicos Locais/sangue , Colecistectomia Laparoscópica/métodos , Cromatografia Líquida/métodos , Estudos de Viabilidade , Feminino , Fundoplicatura/métodos , Humanos , Injeções Intraperitoneais/instrumentação , Injeções Intraperitoneais/métodos , Masculino , Espectrometria de Massas/métodos , Pessoa de Meia-Idade , Medição da Dor/métodos , Estudos Prospectivos , RopivacainaRESUMO
The peripheral venous access remains the first-line method to administer drugs in emergency cases. The intraosseous injection, however, represents a good alternative in difficult situations. In this way the therapy-free period ? the "no flow time" ? and the preclinical rescue time are essentially minimised. The procedure is simple and quickly learnt, also no special features with regard to pharmacotherapy need to be observed. The low flow rate can mostly be compensated for by changing the treatment strategy. In principle, there are no absolute contraindications. The risks can be neglected in the acute emergency situation. Endobronchial and central venous routes for the administration of drugs have now lost their position in the primary preclinical management of emergency patients, except for a few exceptional circumstances.
Assuntos
Serviços Médicos de Emergência/métodos , Medicina de Emergência/instrumentação , Medicina de Emergência/métodos , Injeções Intraperitoneais/instrumentação , Injeções Intraperitoneais/métodos , Sistemas Automatizados de Assistência Junto ao Leito , Desenho de Equipamento , HumanosAssuntos
Antineoplásicos/uso terapêutico , Neoplasias Ovarianas/tratamento farmacológico , Antineoplásicos/administração & dosagem , Carboplatina/administração & dosagem , Carboplatina/uso terapêutico , Cisplatino/administração & dosagem , Cisplatino/uso terapêutico , Feminino , Humanos , Infusões Parenterais/efeitos adversos , Infusões Parenterais/instrumentação , Infusões Parenterais/métodos , Injeções Intraperitoneais/efeitos adversos , Injeções Intraperitoneais/instrumentação , Injeções Intraperitoneais/métodos , Melfalan/administração & dosagem , Melfalan/uso terapêutico , Enfermagem Oncológica , Neoplasias Ovarianas/enfermagem , Neoplasias Ovarianas/patologia , Paclitaxel/administração & dosagem , Paclitaxel/uso terapêutico , Cavidade Peritoneal , Fatores de RiscoRESUMO
Atropine and obidoxime in a parenteral injection device are determined by simple HPLC method simultaneously without any pretreatment at 228 nm. The relative standard deviations (R.S.D.) were below 1.6% for the compounds. The correlation coefficient was greater than 0.999 for both compounds in the calibration range. The recoveries at 5 mg/L concentration averaged as 95% for atropine and 102% for obidoxime. The uncertainty of the measurements for atropine and obidoxime was 2.8% and 2.4%, respectively.
Assuntos
Atropina/análise , Cromatografia Líquida de Alta Pressão/métodos , Injeções Intraperitoneais/instrumentação , Cloreto de Obidoxima/análise , Atropina/administração & dosagem , Calibragem , Cloreto de Obidoxima/administração & dosagem , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Espectrofotometria UltravioletaRESUMO
Intraperitoneal deferoxamine is a well established treatment for aluminum accumulation syndrome in patients with end-stage renal disease receiving peritoneal dialysis, but the use of intraperitoneal deferoxamine has not been described outside of the setting of chronic renal failure. We present here a case of secondary hemochromatosis, complicated by cirrhosis and cardiomyopathy, in which a chronic peritoneal dialysis catheter was used both to treat ascites and to deliver parenteral deferoxamine for iron overload. Daily urinary iron excretion was similar to that achieved when using standard routes of deferoxamine administration. Over a 2-year period, reversal of both the biochemical indicators and the clinical manifestations of iron overload was accomplished.
Assuntos
Desferroxamina/administração & dosagem , Hemocromatose/tratamento farmacológico , Sideróforos/administração & dosagem , Adulto , Cardiomiopatias/complicações , Feminino , Hemocromatose/complicações , Hemocromatose/etiologia , Humanos , Injeções Intraperitoneais/instrumentação , Cirrose Hepática/complicaçõesRESUMO
OBJECTIVE: To provide an overview of access devices used to treat cancers through the arterial, peritoneal, and intraventricular body systems. CONCLUSIONS: Short-term and long-term devices have been developed over the last 35 years for cancer treatment. Although less amenable to standard methods of therapy, the various access devices available to access the arterial, peritoneal, and intraventricular systems have provided a safe and reliable means for drug therapy. Access devices assist in delivering high concentrations of drugs directly to the center of the tumor. Complications and toxicities are inherent with these devices from the drug therapy as well as the device. Nursing assessment can provide early identification of potential problems and implementation of appropriate interventions. IMPLICATIONS FOR NURSING PRACTICE: As the availability of these devices increases, so must the nurse's knowledge base to provide optimal safe care. Oncology nurses are challenged to know the differences between the devices, the device of choice for the individual patient, insertion procedures, and maintenance protocols.
Assuntos
Cateteres de Demora , Infusões Intra-Arteriais/instrumentação , Injeções Intraperitoneais/instrumentação , Injeções Intraventriculares/instrumentação , Neoplasias/tratamento farmacológico , Cateteres de Demora/efeitos adversos , Cateteres de Demora/provisão & distribuição , Quimioterapia do Câncer por Perfusão Regional , Humanos , Infusões Intra-Arteriais/efeitos adversos , Infusões Intra-Arteriais/enfermagem , Injeções , Injeções Intraperitoneais/efeitos adversos , Injeções Intraperitoneais/enfermagem , Injeções Intraventriculares/efeitos adversos , Injeções Intraventriculares/enfermagem , Neoplasias/enfermagem , Avaliação em EnfermagemRESUMO
Intraperitoneal scintigraphy with Tc-99m MAA was performed in nine patients with carcinomatous peritonitis secondary to ovarian or tubal carcinoma. Tc-99m MAA (370 MBq) and NaCl was delivered through an implantable injection port. For patients with good diffusion on intraperitoneal scintigraphy, intraperitoneal chemotherapy was effective. However, for patients with only local diffusion, intraperitoneal chemotherapy was not effective. Intraperitoneal scintigraphy can predict the effectiveness Intraperitoneal scintigraphy can predict the effectiveness of chemotherapy through the implantable injection port.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Ovarianas/diagnóstico por imagem , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Peritoneais/diagnóstico por imagem , Neoplasias Peritoneais/tratamento farmacológico , Agregado de Albumina Marcado com Tecnécio Tc 99m , Adulto , Idoso , Cisplatino/administração & dosagem , Feminino , Fluoruracila/administração & dosagem , Humanos , Injeções Intraperitoneais/instrumentação , Pessoa de Meia-Idade , Neoplasias Ovarianas/patologia , Cavidade Peritoneal/diagnóstico por imagem , Neoplasias Peritoneais/secundário , Valor Preditivo dos Testes , CintilografiaRESUMO
Intraperitoneal chemotherapy was administered to 13 patients with peritoneal carcinomatosis, using acute peritoneal dialysis catheters immediately before the administration of the chemotherapy. A total of 59 cycles were administered, with insertion of the corresponding catheter. There were no inflow or outflow problems and no insertion-related complications. With the removal of the catheter after its use, there is no risk of abdominal infections.
Assuntos
Carboplatina/administração & dosagem , Cateterismo/instrumentação , Cateteres de Demora , Cisplatino/administração & dosagem , Diálise Peritoneal/instrumentação , Adulto , Idoso , Carboplatina/uso terapêutico , Cisplatino/uso terapêutico , Desenho de Equipamento , Feminino , Humanos , Injeções Intraperitoneais/instrumentação , Masculino , Pessoa de Meia-Idade , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Peritoneais/tratamento farmacológico , Indução de Remissão , Taxa de SobrevidaRESUMO
This study reports our preliminary experience with a modified Tenckhoff catheter for intraperitoneal chemotherapy, primarily designed to be larger, longer, and have more perfusion holes. There were 137 catheters implanted in 125 ovarian cancer patients from June 1988 to December 1990, among which 116 were actually used for intraperitoneal chemotherapy. A total of 559 cycles of intraperitoneal chemotherapy was given with a range of 1 to 16 uses per catheter. There were seven infections (6.0%), four inflow obstructions (3.4%), three bowel perforations (2.6%), and one leakage (0.8%). Among patients with catheter infection, three had delayed bowel perforation. Although the incidence of inflow obstruction was reduced from 5.5 to 3.4%, the improvement did not reach statistical significance. The frequency of delayed bowel perforation and infection were similar to the literature experience of other catheters. An unused catheter should be removed to avoid this serious complication. Further study is needed to evaluate fully the performance of this catheter system.
Assuntos
Antineoplásicos/administração & dosagem , Cateteres de Demora , Injeções Intraperitoneais/instrumentação , Neoplasias Ovarianas/tratamento farmacológico , Estudos de Avaliação como Assunto , Feminino , HumanosRESUMO
A hundred and twenty three patients with intraperitoneal cancer (mostly ovarian) were treated between 1980 and 1990 with intraperitoneal chemotherapy administered through a "needle". Local complications were infinitely fewer and less serious than those observed with materials implanted for months. General complications depended on which protocols were being used. But tolerance on the whole was better when the drugs were administered intraperitoneally. This is particularly clear with cisplatin, although the dose is doubled intraperitoneally over a period of 10 months instead of 6. In this ways there was hardly any neurotoxicity and there was a noteworthy prolongation of survival time in cases of ovarian carcinoma.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Injeções Intraperitoneais/efeitos adversos , Neoplasias Peritoneais/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Protocolos Clínicos/normas , Implantes de Medicamento/normas , Seguimentos , Humanos , Injeções Intraperitoneais/instrumentação , Injeções Intraperitoneais/métodosRESUMO
We describe the successful use of combined ascitic-fluid and furosemide infusion as a therapeutic option in the management of massive diuretic-resistant ascites and severe oliguria of hepatic cirrhosis in a 30-year-old Nigerian male farmer. It is simple, safe, convenient and effective treatment modality. The mechanics of this procedure seen against the backgroup of the pathogenesis of sodium retention and renal dysfunction in hepatic cirrhosis is discussed.
Assuntos
Ascite/terapia , Líquido Ascítico , Furosemida/uso terapêutico , Injeções Intraperitoneais/métodos , Cirrose Hepática/complicações , Oligúria/terapia , Adulto , Ascite/tratamento farmacológico , Ascite/etiologia , Furosemida/administração & dosagem , Humanos , Injeções Intraperitoneais/instrumentação , Injeções Intravenosas , Masculino , Oligúria/tratamento farmacológico , Oligúria/etiologiaRESUMO
In patients with minimal residual ovarian carcinoma after aggressive surgical and chemotherapeutic treatment, nephrotoxicity and/or peripheral neuropathy often prohibit continued treatment with intravenous combination cisplatin-based chemotherapy. It is attractive to continue treatment of these patients with intraperitoneal (ip) delivered chemotherapy. From 1981 through 1984 a Tenckhoff catheter was implanted in 59 women for ip chemotherapy after a staging laparoscopy or laparotomy. Minor complications occurred in 8 patients and could be treated conservatively. Ten patients suffered major complications, leading to three (re)laparotomies and catheter extraction in 7 of 10 patients. No patient died of complications, but mean hospitalization time of patients with major complications was 25 days as compared to 11 days for patients without complications. An analysis of nine factors that could lead to postoperative complications failed to reveal a statistically significant risk factor. From this study no profile of a typical high-risk patient emerges.
Assuntos
Antineoplásicos/administração & dosagem , Carcinoma/tratamento farmacológico , Cateterismo/efeitos adversos , Injeções Intraperitoneais/instrumentação , Neoplasias Ovarianas/tratamento farmacológico , Adolescente , Adulto , Idoso , Carcinoma/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/cirurgiaRESUMO
A woman with insulin-dependent diabetes (IDDM) and resistance to subcutaneously injected insulin conceived while being treated with intraperitoneal (i.p.) insulin administered through a recently developed subcutaneous peritoneal access device (SPAD). She continued on this regimen during the pregnancy and at 37 weeks was delivered of a normal baby by Caesarian section. During her pregnancy, she had 2 episodes of infection of the SPAD, which were rapidly controlled by local instillation of antibiotics. Her diabetes remained under excellent control (HbA1: 7.3-7.5%) throughout her pregnancy. This case demonstrates that in such patients i.p. administration of insulin through a SPAD is a feasible mode of management during pregnancy.