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Intrathecal drug therapy

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https://www.readbyqxmd.com/read/28431478/successful-treatment-of-multidrug-resistant-acinetobacter-baumannii-meningitis-with-ampicillin-sulbactam-in-primary-hospital
#1
Leitao Sun, Xiaohong Wang, Zefu Li
INTRODUCTION: Acinetobacter baumannii nosocomial infections, especially those due to multi-drug resistant strains, are increasingly detected. We want to find the effective treatment measures about multi-resistant Acinetobacter baumannii infections through this research. METHODOLOGY: The clinical features and the outcomes of twelve cases of nosocomial Acinetobacter baumannii meningitis treated with ampicillin sulbactam and intrathecal use of amikacin are reported in primary hospital...
April 21, 2017: British Journal of Neurosurgery
https://www.readbyqxmd.com/read/28431428/computational-and-in-vitro-experimental-investigation-of-intrathecal-drug-distribution-parametric-study-of-the-effect-of-injection-volume-cerebrospinal-fluid-pulsatility-and-drug-uptake
#2
Kevin M Tangen, Roxanne Leval, Ankit I Mehta, Andreas A Linninger
BACKGROUND: Intrathecal drug delivery is an attractive option to circumvent the blood-brain barrier for pain management through its increased efficacy of pain relief, reduction in adverse side effects, and cost-effectiveness. Unfortunately, there are limited guidelines for physicians to choose infusion or drug pump settings to administer therapeutic doses to specific regions of the spine or the brain. Although empiric trialing of intrathecal drugs is critical to determine the sustained side effects, currently there is no inexpensive in vitro method to guide the selection of spinal drug delivery parameters...
May 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28400376/therapy-reduction-in-patients-with-down-syndrome-myeloid-leukemia-the-international-ml-ds-2006-trial
#3
Madita Uffmann, Mareike Rasche, Martin Zimmermann, Christine von Neuhoff, Ursula Creutzig, Michael Dworzak, Lenie Scheffers, Henrik Hasle, C Michel Zwaan, Dirk Reinhardt, Jan-Henning Klusmann
Children with Down syndrome and myeloid leukemia (ML-DS) have a superior outcome compared to non-DS patients, but suffer from higher constitutional susceptibility to cytotoxic drugs. We analyzed the outcome of 170 pediatric patients with ML-DS enrolled in the prospective, multi-center, open-label, non-randomized ML-DS 2006 trial, by the NOPHO, DCOG and AML-BFM study groups. In comparison to the historical control arm (reduced intensity protocol for ML-DS patients from the AML-BFM 98 trial) treatment intensity was reduced by lowering the cumulative dose of etoposide (950 mg/m(2) to 450 mg/m(2)) and intrathecal CNS-prophylaxis while omitting maintenance therapy...
April 11, 2017: Blood
https://www.readbyqxmd.com/read/28340041/bleeding-complications-in-patients-undergoing-intrathecal-drug-delivery-system-implantation
#4
Nafisseh S Warner, Markus A Bendel, Matthew A Warner, Jacob J Strand, Halena M Gazelka, Bryan C Hoelzer, William D Mauck, Tim J Lamer, Daryl J Kor, Susan M Moeschler
Introduction.:  Intrathecal drug delivery systems (IDDSs) have dramatically improved analgesia and the functional status of cancer patients and those with chronic pain states. However, given the close proximity to the neuraxis and frequent concomitant use of antiplatelet or anticoagulant medications, this intervention is not without risk. The goal of this investigation was to determine the incidence of bleeding complications following IDDS placement. Methods.:  This is a retrospective review from 2005 through 2014 of adult patients undergoing IDDS implantation or revision at a tertiary care center...
March 3, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28296770/evaluation-of-intrathecal-drug-delivery-system-for-intractable-pain-in-advanced-malignancies-a-prospective-cohort-study
#5
Shuyue Zheng, Liangliang He, Xiaohui Yang, Xiuhua Li, Zhanmin Yang
Pain is prevalent in advanced malignancies; however, some patients cannot get adequate pain relief by conservative routes of analgesic administration or experience serious side effects related to high dose of opioids. For those who have exhausted multimodal conservative analgesic, intrathecal drug delivery is an alternative intervention for truly effective pain management. The objective of this study was to evaluate the clinical efficacy and safety of intrathecal drug delivery system (IDDS) for the treatment of intractable pain in advanced cancer patients...
March 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28271991/new-therapy-for-spinal-muscular-atrophy-offers-modest-bang-for-pharamaceutical-buck
#6
Thomas Morrow
Spinraza is a breakthrough, no doubt. It is a survival SMN-2-directed antisense oligonucleotide indicated for the treatment of SMA in pediatric and adult patients and is administered by injections into the spinal fluid (intrathecally). But it is another ultraexpensive drug, and the evidence so far points to a modest improvement in motor milestones.
February 2017: Managed Care
https://www.readbyqxmd.com/read/28230014/nimotuzumab-treatment-and-outcome-analysis-in-patients-with-leptomeningeal-metastasis-from-nonsmall-cell-lung-cancer
#7
Yanfang Ju, Jinliang Wang, Shengjie Sun, Shunchang Jiao
OBJECTIVE: Leptomeningeal metastasis (LM) leades a devastating consequence in patients with nonsmall cell lung cancer(NSCLC). Treatment is very limited for patients with LM. We introduced to use nimotuzumab (also known as h-R3) combined with methotrexate for treating LM in NSCLC patients. PATIENTS AND METHODS: In the present report, twenty patients with LM of NSCLC were included, and the clinicopathology information and outcomes after treatment were analyzed. RESULTS: All the twenty patients with LM were lung adenocarcinoma...
December 2016: Journal of Cancer Research and Therapeutics
https://www.readbyqxmd.com/read/28212183/cxcl12-cxcr4-signaling-contributes-to-the-pathogenesis-of-opioid-tolerance-a-translational-study
#8
Chih-Peng Lin, Kai-Hsiang Kang, Huang-Ju Tu, Ming-Yueh Wu, Tzu-Hung Lin, Houng-Chi Liou, Wei-Zen Sun, Wen-Mei Fu
BACKGROUND: Long-term opioid therapy for chronic pain may lead to analgesic tolerance, especially when administered intrathecally, thus preventing adequate pain relief. Discovering drug targets to treat opioid tolerance using a mechanism-based approach targeting opioid-induced neuroinflammation provides new therapeutic opportunities. In this study, we provide translational evidence that CXCL12/CXCR4 signaling contributes to the pathogenesis of opioid tolerance. METHODS: The CXCL12 levels in the cerebrospinal fluid of opioid-tolerant patients were compared with those of opioid-naive subjects...
March 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28156637/complications-of-intrathecal-pump-therapy-in-malignancy-related-pain
#9
Egidio Del Fabbro
102 Background: Intrathecal pumps (ITP) are used to manage severe malignancy related pain by delivering analgesics directly into the cerebrospinal fluid, in theory allowing for a reduced opioid dose and fewer complications. Although there is literature to support efficacy in patients with cancer, including improved survival, this mode of drug delivery also carries a risk of serious complications. Reports of complications in non-malignant pain suggest the risks and mortality related to ITP may be under-appreciated and that injury and liability occur with both ITP placement and ITP maintenance...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28105588/nogo-a-antibodies-for-progressive-multiple-sclerosis
#10
Benjamin V Ineichen, Patricia S Plattner, Nicolas Good, Roland Martin, Michael Linnebank, Martin E Schwab
Most of the current therapies, as well as many of the clinical trials, for multiple sclerosis (MS) target the inflammatory autoimmune processes, but less than 20% of all clinical trials investigate potential therapies for the chronic progressive disease stage of MS. The latter is responsible for the steadily increasing disability in many patients, and there is an urgent need for novel therapies that protect nervous system tissue and enhance axonal growth and/or remyelination. As outlined in this review, solid pre-clinical data suggest neutralization of the neurite outgrowth inhibitor Nogo-A as a potential new way to achieve both axonal and myelin repair...
January 19, 2017: CNS Drugs
https://www.readbyqxmd.com/read/28045655/practical-aspects-of-the-use-of-intrathecal-chemotherapy
#11
Raquel Olmos-Jiménez, Alberto Espuny-Miró, Carlos Cárceles Rodríguez, María Sacramento Díaz-Carrasco
INTRODUCTION: Intrathecal chemotherapy is frequently used in clinical practice for treatment and prevention of neoplastic meningitis. Despite its widespread use, there is little information about practical aspects such as the volume of drug to be administered or its preparation and administration. OBJECTIVE: To conduct a literature review about practical aspects of the use of intrathecal chemotherapy. MATERIALS: Search in PubMed/ Medline using the terms "chemotherapy AND intrathecal", analysis of secondary and tertiary information sources...
January 1, 2017: Farmacia Hospitalaria
https://www.readbyqxmd.com/read/28042914/the-polyanalgesic-consensus-conference-pacc-recommendations-for-intrathecal-drug-delivery-guidance-for-improving-safety-and-mitigating-risks
#12
REVIEW
Timothy R Deer, Jason E Pope, Salim M Hayek, Tim J Lamer, Ilir Elias Veizi, Michael Erdek, Mark S Wallace, Jay S Grider, Robert M Levy, Joshua Prager, Steven M Rosen, Michael Saulino, Tony L Yaksh, Jose A De Andrés, David Abejon Gonzalez, Jan Vesper, Stefan Schu, Brian Simpson, Nagy Mekhail
INTRODUCTION: Intrathecal therapy is an important part of the pain treatment algorithm for chronic disease states. The use of this option is a viable treatment strategy, but it is inherent for pain physicians to understand risk assessment and mitigation. In this manuscript, we explore evidence and mitigating strategies to improve safety with intrathecal therapy. METHODS: A robust literature search was performed covering January 2011 to October 9, 2016, in PubMed, Embase, MEDLINE, Biomed Central, Google Scholar, Current Contents Connect, and International Pharmaceutical Abstracts...
February 2017: Neuromodulation: Journal of the International Neuromodulation Society
https://www.readbyqxmd.com/read/28042906/the-polyanalgesic-consensus-conference-pacc-recommendations-for-trialing-of-intrathecal-drug-delivery-infusion-therapy
#13
REVIEW
Timothy R Deer, Salim M Hayek, Jason E Pope, Tim J Lamer, Maged Hamza, Jay S Grider, Steven M Rosen, Samir Narouze, Christophe Perruchoud, Simon Thomson, Marc Russo, Eric Grigsby, Daniel M Doleys, Marilyn S Jacobs, Michael Saulino, Paul Christo, Philip Kim, Elliot Marc Huntoon, Elliot Krames, Nagy Mekhail
INTRODUCTION: Intrathecal (IT) drug infusion is an appropriate and necessary tool in the algorithm to treat refractory cancer and noncancer pain. The decision-making steps/methodology for selecting appropriate patients for implanted targeted drug delivery systems is controversial and complicated. Therefore, a consensus on best practices for determining appropriate use of IT drug infusion may involve testing/trialing this therapy before implantation. METHODS: This current Polyanalgesic Consensus Conference (PACC) update was designed to address the deficiencies and emerging innovations since the previous PACC convened in 2012...
February 2017: Neuromodulation: Journal of the International Neuromodulation Society
https://www.readbyqxmd.com/read/28042904/the-polyanalgesic-consensus-conference-pacc-recommendations-on-intrathecal-drug-infusion-systems-best-practices-and-guidelines
#14
REVIEW
Timothy R Deer, Jason E Pope, Salim M Hayek, Anjum Bux, Eric Buchser, Sam Eldabe, Jose A De Andrés, Michael Erdek, Dennis Patin, Jay S Grider, Daniel M Doleys, Marilyn S Jacobs, Tony L Yaksh, Lawrence Poree, Mark S Wallace, Joshua Prager, Richard Rauck, Oscar DeLeon, Sudhir Diwan, Steven M Falowski, Helena M Gazelka, Philip Kim, Michael Leong, Robert M Levy, Gladstone McDowell, Porter McRoberts, Ramana Naidu, Samir Narouze, Christophe Perruchoud, Steven M Rosen, William S Rosenberg, Michael Saulino, Peter Staats, Lisa J Stearns, Dean Willis, Elliot Krames, Marc Huntoon, Nagy Mekhail
INTRODUCTION: Pain treatment is best performed when a patient-centric, safety-based philosophy is used to determine an algorithmic process to guide care. Since 2007, the International Neuromodulation Society has organized a group of experts to evaluate evidence and create a Polyanalgesic Consensus Conference (PACC) to guide practice. METHODS: The current PACC update was designed to address the deficiencies and innovations emerging since the previous PACC publication of 2012...
February 2017: Neuromodulation: Journal of the International Neuromodulation Society
https://www.readbyqxmd.com/read/28025375/intrathecal-therapy-for-cancer-related-pain
#15
REVIEW
Brian M Bruel, Allen W Burton
OBJECTIVE: The increasing incidence of cancer survivorship has shifted treatment of cancer-related pain from short-term analgesia to long-term chronic pain management. As a result, alternatives to oral analgesics, such as intrathecal therapy, may be beneficial for patients with cancer-related pain. The authors review the use of intrathecal therapy in the management of cancer-related pain. METHODS: The Medline database was searched for English-language articles that included "ziconotide" or "morphine" AND ("cancer" OR "malignant") AND "intrathecal" in title or abstract...
December 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28024493/-clinicopathological-features-of-primary-central-nervous-system-lymphoma-and-their-influence-on-prognosis-of-desease
#16
Chao-Yang DU, Ru-Yu Yang, Chao Li, Li-Juan Duan
OBJECTIVE: To study the clinical features of of patients with primary central nervous system lymphoma(PCNSL) and their influence on prognosis. METHODS: Forty-two cases of PCNSL hospitallized in our hospital from January 2012 to December 2015 were selected, and the laboratory analysis, imaging examination, bone marrow analysis and pathological examination all were performed, 26 cases were treated by lumbar puncture combined with intrathecal injection of drugs (Ara C, dexamethason and methotrexate), 8 cases were treated by methotrexate combined with rituximab, 8 cases voluntanly abandon treatment after being diagnosed as PCNSL...
December 2016: Zhongguo Shi Yan Xue Ye Xue za Zhi
https://www.readbyqxmd.com/read/28007291/-complex-regional-pain-syndrome-a-review
#17
Berenice Carolina Hernández-Porras, Ricardo Plancarte-Sánchez, Silvia Alarcón-Barrios, Marcela Sámano-García
BACKGROUND: Complex regional pain syndrome is characterized by spontaneous or induced pain disproportionate in relation to the initial event and is accompanied by a variety of regional and motor disturbances, leading to a variety of clinical presentations. It is often associated with surgery and minor trauma. PATHOPHYSIOLOGY: Three mechanisms are postulated: changes secondary to post traumatic inflammation, peripheral vasomotor dysfunction and structural and functional changes of the central nervous system as a result of maladaptation...
December 19, 2016: Cirugia y Cirujanos
https://www.readbyqxmd.com/read/27974589/tigecycline-therapy-in-an-infant-for-ventriculoperitoneal-shunt-meningitis
#18
Melike Emiroglu, Gulsum Alkan, Hatice Turk Dagi
Shunt infections are seen in 3% to 20% of patients who have cerebrospinal fluid (CSF) shunts. Although the staphylococcal species are the most common cause of shunt-related infections, Gram-negative bacteria are increasingly reported with higher mortality rates. Tigecycline, a glycylcycline, is not approved for children. But in the era of nosocomial infections due to multidrug-resistant pathogens, it can be the life-saving option. We report an infant with ventriculoperitoneal shunt-related meningitis treated with a tigecycline combination regimen...
January 2017: Pediatrics
https://www.readbyqxmd.com/read/27771111/ziconotide-intrathecal-delivery-as-treatment-for-secondary-therapeutic-failure-of-motor-cortex-stimulation-after-6%C3%A2-years
#19
J Voirin, I Darie, D Fischer, A Simon, I Rohmer-Heitz, F Proust
INTRODUCTION: Motor cortex stimulation is a well-known treatment modality for refractory neuropathic pain. Nevertheless, some cases of therapeutic failure have been described but alternative therapies for these cases are rarely reported. CASE REPORT: The patient presented with neuropathic pain in his right arm due to a cervical syrinx which was surgically treated by a shunt in 2003 with no clinical improvement. As alternative therapy, after an evaluation by repetitive magnetic transcranial stimulation with significant benefit, motor cortex stimulation was successfully implanted in 2004...
October 2016: Neuro-Chirurgie
https://www.readbyqxmd.com/read/27699254/dynamic-dual-isotope-molecular-imaging-elucidates-principles-for-optimizing-intrathecal-drug-delivery
#20
Daniel A Wolf, Jacob Y Hesterman, Jenna M Sullivan, Kelly D Orcutt, Matthew D Silva, Merryl Lobo, Tyler Wellman, Jack Hoppin, Ajay Verma
The intrathecal (IT) dosing route offers a seemingly obvious solution for delivering drugs directly to the central nervous system. However, gaps in understanding drug molecule behavior within the anatomically and kinetically unique environment of the mammalian IT space have impeded the establishment of pharmacokinetic principles for optimizing regional drug exposure along the neuraxis. Here, we have utilized high-resolution single-photon emission tomography with X-ray computed tomography to study the behavior of multiple molecular imaging tracers following an IT bolus injection, with supporting histology, autoradiography, block-face tomography, and MRI...
February 25, 2016: JCI Insight
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