Development of a rat capnoperitoneum phantom to study drug aerosol deposition in the context of anticancer research on peritoneal carcinomatosis.

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.

A resistance-sensing mechanical injector for the precise delivery of liquids to target tissue.

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.

Assessment of the aerosol distribution pattern of a single-port device for intraperitoneal administration of therapeutic substances.

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.

Pressurized intraperitoneal aerosol chemotheprapy after misdiagnosed gastric cancer: Case report and review of the literature.

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.

A Novel, Low-Cost Anesthesia and Injection System for Zebrafish Researchers.

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.

An Affordable Intraperitoneal Injection Setup for Juvenile and Adult Zebrafish.

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.

Eficacia de la ropivacaína 0, 1 % intraperitoneal en el control del dolor postoperatorio en cirugía ginecológica laparoscópica / Effectiveness of intraperitoneal 0.1% ropivacaine to control postoperative pain after undergoing gynaecological laparoscopic surgery

Introduccion: Determinar la eficacia de la administration pre-incisional de ropivacaina al 0,1 % intraperitoneal en el control del dolor abdominal y/o de hombro, durante la primera semana de la cirugia laparoscopica ginecologica benigna. Diseho: Ensayo clinico aleatorizado y doble ciego. Material y metodos: Se realizo un ensayo clinico aleatorizado y doble ciego donde participaron 64 pacientes ASA I-III sometidas a cirugia laparoscopica ginecologica por patologia benigna. Tras la realization del neumoperitoneo, se administraron 100 ml de ropivacaina 0,1 % o suero fisiologico intraperitoneal, dependiendo del grupo al que pertenecieran. Las pacientes recibieron, ademas, AINE junto con una bomba de PCA con option de morfina de rescate como analgesia multimodal asociada. Se evaluo el dolor abdominal y/o de hombro al despertar, en reposo y en movimiento, a los 5, 30, 60 y 120 minutos, asi como a las 24 horas. Se registro el consumo de morfina en las primeras 24 horas y la incidencia de nauseas y/o vomitos postoperatorios. A la semana, mediante encuesta telefonica, se registro la presencia de dolor de hombro a partir de las 24 horas, asi como de dolor abdominal persistente al 1° dia. Resultados: No se observaron diferencias significativas en el ENV durante las primeras 24 horas. Tampoco se observaron diferencias en el consumo de morfina, en la incidencia de nauseas y/o vomitos o en el dolor de hombro. Se evidenciaron diferencias estadisticamente significativas en la incidencia de dolor abdominal persistente al 7a dia (18,52 % en grupo tratamiento vs. 57,58 % en grupo control con p = 0,04). Conclusiones: La administration intraperitoneal preincisional de 100 ml de ropivacaina 0,1 % en comparacion con la administration de suero fisiologico, en el contexto de una tecnica anestesica y analgesica multimodal, no ha demostrado reducir el dolor postoperatorio, el consumo de opioides ni la incidencia de nauseas y vomitos postoperatorios en las primeras 24 horas. Tampoco ha demostrado reduction del dolor de hombro a partir del primer dia tras cirugia laparoscopica ginecologica. El uso de ropivacaina al 0,1 % intraperitoneal preincisional presenta una diminution estadisticamente significativa en la incidencia de dolor abdominal persistente al septimo dia de postoperatorio (AU)

Introduction: Determine the efficacy of preincisional ropivacaine 0,1 % intraperitoneal administration to control abdominal and/or shoulder pain after gynaecological laparoscopic surgery during the first week. Design: Randomized and double-blinded trial. Material and methods: 64 ASA I-III patients undergoing gy-naecological laparoscopic surgery for benign pathology were selected. After the pneumoperitoneum was done, 100 ml of 0.1 % ropivacaine or saline were administered intraperioteneally. Patients received multimodal analgesia. Besides, a morphine PCA pump with a bolus option was prescribed. Abdominal and/or shoulder pain were assessed, at rest and in motion, on waking up from anaesthesia, to 5,30,60 and 120 minutes and at 24 hours from the surgery. Morphine consumption were recorded in the first 24 hours and the presence of nausea and/or vomiting postoperatively. A week after the surgery, by a telephone survey, the shoulder pain after and the persistent abdominal pain on the seventh day was recorded. Results: No significant differences in the ENV scale during the first 24 hours were observed. No differences in morphine consumption, in the incidence of nausea and/or vomiting or shoulder pain were observed. Statistically significant differences were noted in the incidence of persistent abdominal pain on the seventh day (18.52 treatment group vs. 57,58 % in control group with a p value 0.04). Conclusions: The preincisional intraperitoneal administration of 100 ml of ropivacaine 0.1 % compared to administration of saline, in the context of an anesthetic and analgesic multimodal technique has not been shown to reduce postoperative pain, opioid consumption and the incidence of nausea and postoperative vomiting in the first 24 hours. Nor has it shown reduction of shoulder pain from the first day after undergoing gynecological laparoscopic surgery. Ropivacaine 0.1 % intraperitoneal preincisional may be useful in the control of abdominal pain which persists on the seventh day (AU)

Total systemic ropivacaine concentrations following aerosolized intraperitoneal delivery using the AeroSurge.

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.

"Gain more working space at a low intraperitoneal pressure" may be a difficult, but worthy anesthesiologic challenge / Obtener un mayor espacio de trabajo a presiones intraperitoneales bajas: un reto difícil pero meritorio

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Experiencia en la administración de quimioterapia intraperitoneal en una unidad de diálisis peritoneal / No disponible

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[The intraosseous access in preclinical emergency medicine - indication, equipment and procedure]. / Der intraossäre Zugang in der präklinischen Notfallmedizin - Indikationen, Equipment und Durchführung.

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.

Simple high-performance liquid chromatographic method for determination of atropine and obidoxime in a parenteral injection device.

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.

Long-term intraperitoneal deferoxamine for hemochromatosis.

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.

Arterial, peritoneal, and intraventricular access devices.

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.

Prediction of effectiveness of intraperitoneal chemotherapy by intraperitoneal scintigraphy in patients with advanced ovarian carcinoma.

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.

Use of acute peritoneal dialysis catheters for intraperitoneal chemotherapy instead of the semipermanent/permanent Tenkhoff catheters.

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.

Preliminary experience with a modified Tenckhoff catheter for intraperitoneal chemotherapy.

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.

[Complications of intraperitoneal chemotherapy by the needle technique. Evaluation after ten years]. / Complications de la chimiothérapie intrapéritonéale par la technique à l'aiguille. Bilan à 10 ans.

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.